tag:blogger.com,1999:blog-17221577299070291392024-02-19T12:30:51.368+01:00ChroniclesThoughts and experiences on Healthcare and eHealth entrepreneurship in Nigeria 1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.comBlogger22125tag:blogger.com,1999:blog-1722157729907029139.post-69108966878231190472014-07-14T11:23:00.000+02:002014-07-19T02:36:15.662+02:00The entrepreneurship bugSo i caught the entrepreneurship bug!<br />
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It was the start of May 2014, I'd over the preceding weeks had a family member in Abuja, Nigeria who had some health issues. The travails we experienced in attempting to get quality care was distressing. Particularly as finances were not the limiting factor but rather systemic issues that conspired to provide mediocre care.<br />
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As i pondered on this problem i suddenly got the bright spark of an idea that would improve the quality of the health system. The idea filled me with such excitement that i wanted to quit my job right away and jump on a plane to get started on my idea.<br />
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Unfortunately reality soon set in, I had bills to pay, a family to raise etc. I was convinced however that i was on to something. In my mind's eye i had this vision of the wonderful change my innovation could bring. The next logical thing for me to do was to put it down in writing, my business plan was born! I spent hours and days without sleep working on it. I've subsequently gone on to find out the traditional business plan has fallen out of favour particular in tech ventures - my bright idea is a tech venture that aims to improves the quality of healthcare.<br />
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So while i had the momentum i bought a domain and webhosting on the 11th of may. Money had been spent i was committed!<br />
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Now this may not apply for others but for me, writing down a business plan was useful as it helped solidify my thoughts and forced me to do more research and gain more knowledge. The more work i did the more of a knowledge gap i realised i had. Next step thus was to hit my local library. I browsed the business and IT sections and picked up 2 books - 'the lean startup' by Eric ries and 'how to start a tech business' by Alex cowan. I went on to find out that the former book was a huge bible for tech startups.<br />
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...And so my study began.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-13087162580335509842014-04-25T04:27:00.004+02:002014-07-14T10:49:01.998+02:00Key performance indicators<div style="font-family: arial; font-size: small;">
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" /></div>
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Browsing the intranet of my hospital, I came across the quarterly hospital health target report.</div>
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The report consisted of parameters the ministry of health requires all hospitals to report. These parameters are in areas the ministry feel are important goals - so called 'health priorities'- that are to be met in order to fulfill the need of the population accessing healthcare.</div>
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This is not a new phenomenon, the idea of key performance indicators (KPIs) is wide spread in business and is used to judge performance as well as highlight areas for improvement.</div>
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It is also a useful goal setting strategy that helps keep the goal always in focus. While it can be detrimental in that focus may start to shift to numbers than perhaps what the numbers are trying to achieve, it is felt to be generally a good thing that most organizations and governments imbibe.</div>
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A look at the KPIs for this particular health ministry, summarized in a webpage that houses the results reveal targets in:</div>
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- Shorter stays in emergency department - 95 percent of patients will be admitted, discharged, or transferred from an emergency department within six hours.</div>
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- Improved access to elective surgery - volume to increase by 4000 discharges per year</div>
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- Increased immunization - 90 percent of 8 month olds will have their primary course of immunization on time</div>
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- Shorter waits for cancer treatment - all patients ready for treatment wait less than 4 weeks</div>
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- Better help for smokers to quit - 95 percent of hospitalized patients who smoke and are seen by a health practitioner in public hospitals and 90 percent of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking.</div>
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- More heart and diabetes checks - 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.</div>
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The data from different regions are collated and a quarterly reported published. One is then able to compare data across different areas and times for the whole country. The public are aware of it and have certain expectations when they access health care. Staff also have defined targets to work towards in their everyday roles</div>
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Over time it is easy to see where one needs to appropriately target interventions or employ different management strategies to ensure improvement. </div>
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These indicators are obviously well thought out, with specific numeric targets. It shows homework has been done and the government has chosen priority areas to invest time and effort to improve the well being of the population. It is also safe to conclude that systems exist to gather this information.</div>
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Seeing this, i did a google search for any similarity in the Nigerian health system. To my surprise i came across a national health plan. The plan was laudable in that it was quite a detailed document that had reasonably specific targets and KPIs. The more i read the more obvious it became to me that quite a lot of work had been put into it. But as often is the case with Nigeria, many a great reports are left to rot on government shelves while the status quo carries on.<br />
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Where the plan was further let down was the lack of data. Several indicators couldn't be measured as the data just wasn't available. Furthermore the number of KPIs were large, this in my opinion defeats the purpose.<br />
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What is needed is something like the much maligned 7 point plan of former president Yar'adua (God rest his soul).<br />
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7 indicators with achievable goals, monitored quarterly, easily measurable and impactful in the day to day health of the average individual. This should then be easily accessible to the general public who can compare, contrast and put pressure on the right people when needs be to make sure things get done.<br />
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Of course more systems for data collection needs to be put in place to facilitate this and people and healthcare workers need to be educated and carried along. All in all it's not that difficult, all that's needed is the will and we know that when there's a will there's a way!<br />
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1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-61582164131582923292013-09-06T13:53:00.002+02:002013-09-06T14:05:56.970+02:00Emergency medical service - As simple as ABC<div style="text-align: center;">
<img 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" /></div>
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I'm currently doing a stint in the Emergency department in a country in the Pacific working alongside great doctors and nurses. They all do a great job saving lives and providing good service to the local community. It made me think of what options exist in my beloved homeland Nigeria for people in need of emergency medical attention.<br />
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A Google search of 'emergency medicine nigeria' doesn't yield much evidence of a structured approach to the delivery of emergency care. Several websites allude to the non-existence of a working state ambulance service or a national emergency telephone number such as a '111', '911' or '999' (depending on where in the world you are).<br />
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Thankfully some private groups have attempted to fill the gap but their attempts sadly fall short of what is needed. Their services while laudable are either not skilled enough or not well publicized. What's more deterring is the phone numbers they encourage people dial in case of an emergency. The numbers are often longer than the numbers on a lottery ticket! tough enough to remember on a good day, much worse when in the panic stricken state of an emergency. Reminds me of an episode of 'IT crowd' where '999' is changed to '011 899 988 199...' (See video<a href="http://www.youtube.com/watch?v=0usJCEUgWyM" target="_blank"> here</a>) Perhaps they should try a similarly catchy song! <br />
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The poor state of the existing situation is seen here in a Nigerian paper on Pubmed (<a href="http://www.ncbi.nlm.nih.gov/pubmed/19562917" target="_blank">read here</a>). The authors tracked over four years how victims of rood traffic accidents presented to an emergency department in Ilorin. A whooping 52% of victims were brought in by relatives and 40% by police or FRSC. In the majority of these instances no intervention was given during transport, furthermore none of the transporters were trained in any type of life support, not even the police or FRSC officers! This paper makes dire reading!<br />
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So now one has somehow made their way - against many odds- to the emergency room, what service do they expect to receive? Stories abound on how patients are required to deposit large amounts of money before they are attended to (follow my friends blog <a href="http://amahzeeing.blogspot.co.nz/">http://amahzeeing.blogspot.co.nz/</a> who writes from the front line on some of the problems plaguing our hospitals)<br />
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When money is finally deposited, one obstacle after another surfaces. an instance of a fatal obstacle i read recently is that of a vibrant young girl (<a href="http://stella-damasus.blogspot.co.nz/2013/02/we-have-killed-us.html" target="_blank">read here</a>) who was having an acute asthma attack. She arrived at a hospital that had no supply of oxygen thus had to seek attention elsewhere but sadly passed away before she could be treated. Tell me please how can an emergency room not have oxygen! It's simple ABC - Airway, breathing, circulation. If an emergency room can't manage ABC it has no business taking emergencies or calling itself an emergency room.<br />
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A similarly sad story was told to me during my medical elective in Nigeria. It goes as follows: a patient had come in severely distressed and was in danger of losing his airway. A call was made to secure the airway through the placement of a tube that goes directly into the windpipe, to do this one needs a laryngoscope. Okay so people run around frantically searching for the scope and finally find it! yay, a life will be saved, not quite. The scope has no batteries to power it. Another frantic search for batteries ensues, yay! a drawer full of batteries found, a life will be saved. Not quite. The drawer is locked and the key holder is nowhere to be found. A life slips away.<br />
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The system (used here in the most liberal sense of the word) is broken from top to bottom, nothing works. Nil to few people really care. More must be done, life cannot be as trivial as it currently is. Other than the obvious setting up of an emergency number and a good ambulance service the following suggestions in my opinion can improve emergency care as it currently is:<br />
- All secondary school students should be taught the rudiments of life support,<br />
- Police and road safety officers should be required to learn basic life support and<br />
- Emergency departments need to be tightly regulated to ensure they possess a bare minimum of materials and services or be shut down.<br />
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I believe if the above are implemented a big difference will be observed in our emergency care in Nigeria. They are not too difficult to do and is not to much to ask, all that's needed is the will. It's really as simple as ABC 1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-134082335599466802013-02-17T22:08:00.002+01:002013-02-17T22:09:45.716+01:00<div class="separator" style="clear: both; text-align: center;">
<a href="http://tenthousanddonors.org/images/edit1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://tenthousanddonors.org/images/edit1.jpg" width="297" /></a></div>
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I recently came across a <a href="http://tenthousanddonors.org/index.html" target="_blank">website</a> that aims to build up the blood donor database in Nigeria. It's by a group called the one percent project who want to create a 10,000 strong army of volunteers who regularly donate blood.<br />
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This is a laudable project that i support fully. Read <a href="http://docneto.blogspot.ie/2012/12/blood.html" target="_blank">here</a> my post on blood.<br />
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It's not everyday you get a chance to <a href="http://tenthousanddonors.org/index.html" target="_blank">'Be a hero, it's in your blood'</a>.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-30585081788975823632013-02-05T01:01:00.001+01:002013-02-05T01:15:12.694+01:00Of medical errors<br />
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<img src="https://encrypted-tbn1.gstatic.com/images?q=tbn:ANd9GcS-1XQdg-ZZGV7Zgxwgj7wZGHnfBmMllfEnfzwiwVtTDboK99So" /></div>
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Here's a great anecdote lifted from the blog of Dr Kavanagh a rheumatologist:<br />
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In my first few months working as a rheumatologist a referral letter arrived from a local doctor about a lady with rheumatoid arthritis. She had recently moved to the West of Ireland from the UK, where her original diagnosis had been made. Her GP had originally referred her to a general physician in a small local hospital who had struggled with her care and she was looking for second opinion.<br />
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After assessing her, it quickly became apparent that original diagnosis had been incorrect. The patient had numerous explanations for her pain other than rheumatoid arthritis and the investigation that was likely to have prompted her original diagnosis (a positive rheumatoid factor test) as due to the fact that she had Sjogren’s syndrome (a condition which causes dryness of the eyes and mouth). <br />
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My specialist pride congratulated itself on making such a clever diagnosis and for being smarter than either the physician who had cared for her of late or the rheumatologist who had made the original diagnosis. Gosh I’m good, I thought.<br />
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‘That’s wonderful news Doctor. You mean I don’t have rheumatoid arthritis after all?’<br />
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‘Not in my opinion you don’t.’<br />
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‘Its great to see someone who knows what he’s talking about. Do you mind me asking where you did your training?’<br />
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‘In the UK. In Cambridge mainly.’<br />
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‘Really Doctor? In Addenbrooke’s?’<br />
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‘I was there for 4 years.’<br />
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‘That’s amazing. That’s where I was told I had rheumatoid.’<br />
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With that she thanked me, stood up to leave, and just before she left the room, turned to me and said;<br />
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‘I knew you looked familiar.’<br />
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It’s never a bad idea to get a second opinion. Even if it’s from your self.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-59100923451123265932012-12-11T00:45:00.001+01:002012-12-11T00:54:18.264+01:00Blood<div class="separator" style="clear: both; text-align: center;">
<a href="https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcTdMCky6_rDnHVt6bBf17LF4aAx3Jc3745et2MdPr8IPBTsXtOQ" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="241" src="https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcTdMCky6_rDnHVt6bBf17LF4aAx3Jc3745et2MdPr8IPBTsXtOQ" width="320" /></a></div>
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Blood courses through the vasculature of mammals bringing vital nutrients to every cell and ferrying waste substances away to be excreted. Blood flowing is synonymous with life, a lack of or stagnation of blood similarly signifying death or at least its proximity. Blood is central to all that the body does. A simple biopsy of it with appropriate testing can reveal the onset of disease, its severity, rate of progression and whether or not disease will respond to treatment. When lost it must be swiftly replaced with a suitable type.<br />
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In the course of treatment of several diseases many lose precious blood. In the natural process of pregnancies, occasions arise where massive blood loss occurs. The people who experience these blood losses are usually in no position to solicit for blood donations to remedy their dire situation. Having managed a few people in these situations the ease with which blood can be accessed is literally a life saver.<br />
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A central system exists where individuals go into clinics to donate blood that is then pooled centrally and dispatched to areas where they are needed. When a person is in need of blood all that's needed is a lab request and blood specifically typed to the individual arrives in no time. Well organized health systems recognize the importance of this community effort and expend a lot of resources encouraging citizens to donate. They also invest in processes and systems that make blood safe and available in a timely manner to whoever needs it.<br />
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Websites of several national blood transfusion services show a blood stock level of how much blood is available nationally. Below is that of the South African blood service:<br />
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<a href="http://www.sanbs.org.za/images/banners/51447_SABNS%20bloodstock%20level-29.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.sanbs.org.za/images/banners/51447_SABNS%20bloodstock%20level-29.jpg" /></a></div>
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The Irish blood service:<br />
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<div id="bloodsupplyltab" style="background-color: white; border-spacing: 0pt; border: 0pt none; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 1.1em; font-weight: bold; margin: 0pt 0pt 5px; padding: 0pt; width: 750px;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 745px;"><tbody>
<tr><td colspan="5"><img alt="" height="2" src="http://www.giveblood.ie/images_upload/images/border-bloodsupply.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="200" /></td></tr>
<tr><td class="bloodsupplyleftborder" rowspan="10" style="border-left-color: rgb(129, 129, 129); border-left-style: solid; border-left-width: 1px;" width="6%"></td><th id="th0928FC780101" scope="col" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
Blood Group</div>
</th><th colspan="2" id="th0928FC780102" scope="col"><div class="bloodsupplytitle" style="border-spacing: 0pt; border: 0pt none; margin: 0pt 0pt 0pt 100px; padding: 0pt; text-align: left;">
Days Blood Supply Remaining</div>
</th><td class="bloodsupplyrightborder" headers="th0928FC780101 th0928FC780102" rowspan="10" style="border-right-color: rgb(129, 129, 129); border-right-style: solid; border-right-width: 1px;" width="6%"></td></tr>
<tr><td width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
</div>
</td><td colspan="2" headers="th0928FC780101"></td></tr>
<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="O+" height="37" src="http://www.giveblood.ie/images_upload/images/O+.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><img alt="Blood supply 5 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-5.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></td></tr>
<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="O-" height="37" src="http://www.giveblood.ie/images_upload/images/O-.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><img alt="Blood supply 5 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-5.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></td></tr>
<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="A+" height="37" src="http://www.giveblood.ie/images_upload/images/A+.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><div class="number" style="border-spacing: 0pt; border: 0pt none; margin: 0pt 0pt 0pt 100px; padding: 0pt; vertical-align: middle;">
<img alt="Blood supply 5 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-5.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></div>
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<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="A-" height="37" src="http://www.giveblood.ie/images_upload/images/A-.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><div class="number" style="border-spacing: 0pt; border: 0pt none; margin: 0pt 0pt 0pt 100px; padding: 0pt; vertical-align: middle;">
<img alt="Blood supply 6 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-6.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></div>
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<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="B+" height="37" src="http://www.giveblood.ie/images_upload/images/B+.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><img alt="Blood supply 8 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-8.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></td></tr>
<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="B-" height="37" src="http://www.giveblood.ie/images_upload/images/B-.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><img alt="Blood supply 4 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-4.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></td></tr>
<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="AB+" height="37" src="http://www.giveblood.ie/images_upload/images/AB+.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><div class="number" style="border-spacing: 0pt; border: 0pt none; margin: 0pt 0pt 0pt 100px; padding: 0pt; vertical-align: middle;">
<img alt="Blood supply 9 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-9.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></div>
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<tr><td class="bloodsupplyline" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;" width="15%"><div align="center" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;">
<img alt="AB-" height="37" src="http://www.giveblood.ie/images_upload/images/AB-.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="36" /></div>
</td><td class="bloodsupplyline" colspan="2" headers="th0928FC780101" style="border-bottom-color: rgb(129, 129, 129); border-bottom-style: solid; border-bottom-width: 1px;"><div class="number" style="border-spacing: 0pt; border: 0pt none; margin: 0pt 0pt 0pt 100px; padding: 0pt; vertical-align: middle;">
<img alt="Blood supply 9 days" src="http://www.giveblood.ie/images_upload/Current_Blood_Supply/supply-9.jpg" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" /></div>
</td></tr>
<tr><td colspan="5"><img alt="" height="10" src="http://www.giveblood.ie/images_upload/images/border-bloodsupply-bottom.gif" style="border-spacing: 0pt; border: 0pt none; margin: 0pt; padding: 0pt;" width="750" /></td></tr>
</tbody></table>
</div>
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<span class="boldblacktext" style="color: black; font-size: 1em; font-weight: bold;">Blood Supply on Friday 7th of December 2012</span></div>
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http://www.americasblood.org/ also has a similar info-graphic for blood supplies in the USA. These supplies in the various countries depend on generous donors who consistently give of themselves with no reward. <br />
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Sadly this well organized system doesn't exist in many other countries around the world - A single statistic to highlight the extent and effect of this dearth: 25% of maternal deaths are attributed to a lack of blood transfusion - In these places one has to anticipate when they will need blood and solicit it accordingly beforehand. I'm guessing everyone in these settings must have a crystal ball that tells them when blood will be needed and where to find suitable donors. Realistically however there are no crystal balls. The systems that work so well to prevent deaths and save lives in SA, Ireland and USA need to be emulated in these settings and made to work. Individuals also need to be proactive and seek to be blood donors, aid the community because no one knows when s/he will need blood. </div>
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It's not everyday we get an opportunity to save lives, make today that day:</div>
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Nigeria blood transfusion service - http://www.nbts.gov.ng/<br />
Kenyan transfusion service - http://www.nbtskenya.org/</div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-43859864100833243302012-12-08T22:45:00.001+01:002012-12-08T22:56:32.741+01:00Pro reason<div style="text-align: justify;">
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The recent death of a pregnant woman in Ireland has caused huge furore in the polity of the republic. While the exact details of the case are yet unknown many have been up in arms over the claim that the pregnant woman's life was lost as a direct result of the prohibition of abortion in Ireland. Many pro life and pro choice groups have clashed repeatedly and the debate rages on. This series of events resurrected in my mind the thoughts I've had regarding abortion. </div>
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Abortion is always a difficult topic and with most difficult topics there usually isn't one right answer. In my mind's eye i can see situations where i will be in favor of abortion. One such instance is that of rape where contrary to <a href="http://www.nytimes.com/2012/08/20/us/politics/todd-akin-provokes-ire-with-legitimate-rape-comment.html?_r=0" target="_blank">Sen. Todd Akin</a>, pregnancy can and does result. Conversely i would be against situations where a pregnancy is unplanned and abortion is used as a form of contraception. Grey areas exist in my mind regarding abortions for fetal abnormalities and severe congenital/ genetic conditions. I can understand why a parent may want an abortion in these cases but I can also see how permitting that would begin a descent down a slippery slope towards eugenics, a practice many will agree is less than desirable. </div>
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I believe that a baby has a right to life. The real issue is determining when that life actually begins. Is it when the sperm fertilizes the egg, when the morula is formed, when the fetal heart begins beating or when... i could go on. The bottom line is we don't know and we probably never will. What i do know though is the immense joy children bring into the world often regardless of the circumstances surrounding their conception or the state of their health at birth. Children bring hope and joy, the possibility of change and a new beginning. They also bring lots of poo and tears but we'll gloss over those! Abortion on the other hand in my experience brings adverse emotional and psychological effects to not a few women. Some psychiatrists argue that research hasn't revealed measurable difference in the mental well being of women who have undergone abortion. I however still have my doubts probably due to the anecdotes i have come across that suggest otherwise. </div>
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Finally you ask, so what should we do? legislate for or against it? What i have thought up is an independent panel that consists of legal and medical experts that women can apply to and have their case for an abortion to be heard swiftly. They'll always be available, take into consideration all the potential issues and ramifications and give a decision accordingly. I know this will give rise to many new issues but that's my little stab at the problem. The real answer: I don't know. I spare a thought often for women who have to consider this difficult option.</div>
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1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-80076463769869955762012-05-04T01:25:00.000+02:002012-12-08T20:58:30.360+01:00Our very own prof<div class="separator" style="clear: both; text-align: center;">
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Prof Osotimehin, former Nigerian health minister is now executive director of the UNFPA.</div>
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After the break is his profile and an interesting interview with him, Culled from the BMJ</div>
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His response to the last question is one that resonates with me.</div>
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The doctor with seven billion patients</div>
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Authors: Guy Rughani </div>
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Publication date: 10 Aug 2011</div>
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Guy Rughani talks to Babatunde Osotimehin, executive director of the United Nations Population Fund</div>
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Name: Babatunde Osotimehin</div>
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Position: Executive director of the United Nations Population Fund (UNFPA) and an under secretary general of the United Nations.</div>
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Biography: Qualified from the University of Ibadan, Nigeria, in 1972 and achieved his doctorate in medicine in 1979 from the University of Birmingham, UK, specialising in clinical pathology. Became a fellow of the Royal College of Physicians of London and in 1990 was elected provost of the Ibadan College of Medicine. He was awarded the prestigious Officer of the Order of the Niger (OON) in 2005. As director general of the Nigerian National Agency for the Control of AIDS and then as Nigeria’s minister of health he led a period of steady decline in the country’s prevalence of HIV and AIDS. He was appointed executive director of the UNFPA in 2011.</div>
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What do you do at the UNFPA?</div>
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My job is an advocacy platform to ensure that we provide empowerment for people to be able to make choices in their reproductive health lives—particularly young people.</div>
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Feeding into that, we are the organisation that helps governments to conduct censuses so that they know what the population of their country is, enabling them to plan more effectively for future young people.</div>
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In northern Europe, where populations seem to be going down, there is concern about maintaining a reproductive base, with governments keen to promote pronatalist policies [encouraging reproduction].</div>
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In the global south [developing world] we have populations that are growing. We work with those governments to ensure that the growth of their populations does not outstrip the growth of their economies—so the people can maintain some sort of dignity.</div>
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We want to arrive at a point where women can have the number of children they want and can look after, and who they can educate and feed.</div>
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Do you find anything at the UNFPA frustrating?</div>
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My frustration is the inability to make things happen as quickly as I want them to. For example, 1000 women die every day giving birth. That is not acceptable. That is something we should be able to prevent because we know what to do. For as long as we cannot put in place the structures, programmes, and policies that are required to make sure that women have access to all they need, it will be frustrating.</div>
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What has been your most rewarding role?</div>
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The most rewarding has been working with the Nigerian government in an effort to control the HIV epidemic. When I started, the prevalence was at almost 6%, and when I left it had dropped to about 4%. And beyond just reducing the prevalence, we had gone from zero to about 300 000 people on treatment. For me, that was something that I could be happy about.</div>
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Going forward, we need to deepen our efforts at prevention and ensure that we don’t get new infections in young people and also ensure that those who require treatment can access treatment. We’ve had lots of programmes that address HIV, but we need to integrate those into a larger context of primary care that provides not just for HIV but also for maternal care, antenatal care, child immunisation, and other things. That standard package of care would deal with more things and would be more cost efficient in, for example, human resources. I think this integration is beginning to happen.</div>
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Did you always want to do medicine?</div>
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Always. I don’t think I ever had an option B. From the day I knew what it was to be a professional, I always wanted to be a doctor. My father was a teacher, and my mother was a teacher, so it wasn’t because there was some inspiration in the family. I just wanted to be a doctor. The most memorable day of my life was that transformation from being Mr Osotimehin to Dr Osotimehin. I was very young, so I was standing there asking myself, “Oh my goodness, so this has happened now?” It was quite momentous for me.</div>
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When you started out did you have any ambition to work on a global scale?</div>
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No. All I wanted to do was be a good doctor. As things turned out, opportunities came along and I just grabbed them.</div>
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How would you advise doctors with ambitions to work for the UN?</div>
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As a doctor, you should want to be a doctor first. Then perhaps do some public health tuition and work in other parts of the world, because that’s what builds you up to be able to appreciate globally what the challenges are before you get to the UN. If you go to the UN as a British doctor, you are very narrow and you don’t know much about what’s going on elsewhere.</div>
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What is the best bit of advice you have ever been given?</div>
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It was given by Sir Raymond Hoffenberg, who later became president of the Royal College of Physicians. I’d finished membership in medicine and did an MD in Birmingham. I wanted to stay and practise in England. He said, “No, you should go back to Nigeria,” and I think that was very good advice. What he told me then holds true today. You will probably help 10 000 or a 100 000 people in this country running a specialist clinic. But think about it—you are going to touch the lives of millions of people if you go back to Nigeria.</div>
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From the Student BMJ.</div>
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Guy Rughani Clegg scholar, BMJ</div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-6986012950614991652011-03-24T01:38:00.002+01:002012-12-08T20:32:17.025+01:00The end is in sight<div style="text-align: justify;">
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As i sit in my room procrastinating another study session for my fast approaching exams, i mull over the journey that medical school has been so far. After 5 years of hard work and studying, i complete my undergraduate medical training in 4 weeks. The time has flown by so quickly, it's been full of many great and memorable experiences as well as many hard times. </div>
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Now it's on to the intern year. I don't yet know where that'll be, maybe in the first world, maybe in the third world, either way i know it will be fun and eventful and full of stories for this blog.</div>
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I hope to write more in the coming months and years</div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-73038416733581551802009-11-25T15:52:00.001+01:002012-12-08T22:54:20.880+01:00Communication skills<div class="separator" style="clear: both; text-align: justify;">
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So I'm back writing again thanks to someone whom I spoke to sometime ago who had read the blog and liked some of it. I'm sure she's representative of millions of others (in my dreams maybe). </div>
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Well speaking to her reminded me of several experiences I had while doing a rotation in surgery at the national hospital Abuja that I'm yet to write about. One such experience I relate below.</div>
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I've been doing psychiatry for the past few weeks and there's been an emphasis on communication skills and its importance in the interaction with the patient. So why tell us about it I hear you ask. It's simple, learning about communication reminded me of the awesome skills of the great surgeon I worked under in the hospital. This is an excerpt of how a consultation with an elderly cancer patient went. </div>
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Says he: 'ah na cancer oh! Wetin we go do!' </div>
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Patient (replies with some trepidation having heard for the first time she has cancer): whatever you say doctor. </div>
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Doctor: we go cut am off.</div>
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Patient: ah! Cut am off?</div>
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Him: yes na. Abi you day use am for anything!</div>
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Where was the cancer I imagine you asking. Well wait for it... it was in her left breast!</div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-83629564094491775942009-11-25T14:58:00.002+01:002012-12-08T23:03:20.976+01:00GNIB<div class="separator" style="clear: both; text-align: justify;">
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I sit now in the waiting hall of the garda (irish police) national immigration bureau waiting to dole out 100 euros to the government for letting me stay in their country. This whole process irks me in so many ways. Why doesn't the Irish government operate a sensible student visa system as most other countries have. What's worse is the treatment one gets is so shoddy, hours are wasted and no real service is given. I wish they'd scrap it altogether. Hardly gonna happen though, think of all the jobs that'll be lost!</div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-56775124168291264262009-08-24T15:16:00.003+02:002009-08-24T15:21:26.979+02:00Back in Dublin<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHXZ9_Kx-CsVhuFj0jpDp3Z0MEdEOqhJEqozztiUHtsF4Mb49E3yd0LzFfTbZDGU46sNy6sznRBCbhsKu63I2X-D6nMxuBwrJttPKlunHT4p0EwrC2Q0_2MoKntZgsZPIQlPr7B5F4n4ow/s1600-h/IMG_0252.JPG"><img style="margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHXZ9_Kx-CsVhuFj0jpDp3Z0MEdEOqhJEqozztiUHtsF4Mb49E3yd0LzFfTbZDGU46sNy6sznRBCbhsKu63I2X-D6nMxuBwrJttPKlunHT4p0EwrC2Q0_2MoKntZgsZPIQlPr7B5F4n4ow/s320/IMG_0252.JPG" alt="" id="BLOGGER_PHOTO_ID_5373519402482547058" border="0" /></a><br />I'm back in Dublin after a rather short six weeks in Nigeria. I've much better internet here so i'll put up some pictures from my time in Nigeria. I'll as well post my thoughts and experiences from my two weeks in surgery, that's if i can remember much at this point.<br /><br />On the left are house officers of the general surgical team and the two females are students just like myself1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-59219811411501849082009-08-07T18:32:00.002+02:002009-08-07T18:43:29.290+02:00HiatusI apologize for not writing anything for the last couple of weeks, I've been both tired and lazy. I finished my two weeks in surgery today, it was quite eventful. The cases and the stories behind them were bizzare, sometimes bordering on outright madness. The cases would fit quite nicely into an episode of ER or Grey's anatomy. <div>From gunshot wounds to stab wounds to machete cuts and road traffic accidents, We saw them all. Late stage breast cancer was a regular occurrence and lumps only appeared in two sizes: large and extra large. <div><br /></div><div>I'll give a retrospective account of my experience in the coming days. for now it's time to rest and enjoy the rest of my holiday. </div></div>1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-43874381678489190102009-07-25T23:33:00.003+02:002012-12-08T20:59:55.964+01:00WeekendIt's the weekend finally, looked earnestly to this weekend to take a break from getting up early and going to the hospital. This week started out slowly but ended up being quite eventful. It was filled with house officers being berated by their seniors left, right and center, rows breaking out between the team and a patient's mom and vehement abuse from a family who lost their mother. <br />
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Monday morning saw my return to the hospital after the week away at the conference. My assigned team wasn't functioning at full capacity yet so i tagged along with another team. Learnt quite a bit from this team and saw a couple of cases of diabetic ketoacidosis (DKA). The phenomenom of DKA is becoming a regular sight in the emergency ward. This is in consinance with the rising trend of diabetics in the developing world as a whole and Nigeria in particular. Diabetes in places like Nigeria is projected to rise many folds if something is not urgently done to reverse the trend in lifestyle. The traditional African lifestyle is less prevalent and a more western lifestlye and diet is becoming more favoured. It seems to me that ignorance plays no small measure in this being the case. It is thought by many that the bigger one is and the more (western) food they consume, the wealthier they are. This leads to many leading a life that isn't much good for their health. Moreover companies such as coca cola has played no small part in the rising incidence of diabetes. This unhealthy new lifestyle is a great folly and will spell doom for those that continue to imbibe it.<br />
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Tuesday came around, the team assembled together for a ward round. First patient: DKA. Management: Rehydrate, give insulin, correct potassium and suspect infection. We had issues getting lab results (for potassium levels) for this patient as some machine had broken down in the lab and there was no replacement (only for naija!). Next patient is a known hypertensive who takes his drugs on occassion. He presents with an adverse effect as a result. He reveals that his inability to 'perform' discourages him from adhering to his meds. The consultant indicates to the rest of the team that it is quite rare for a patient to volunteer information on why they don't comply. A decision is reached to change his meds to something more suitable. The next patient is a seventy year old man (the pidgin english interview) with pneumonia, he seems happy and is recovering well. We proceed to the female patients and start off with the sickle cell girl. Her mom is beside her as always sponging her forehead. Over the night she had had a sudden spike in her non relapsing fever and was given an anti malarial by the doctor on call. This didn't please the team much as they had decided to hold off on all drugs until the cause of the fever is isolated. This precipitated a heated disagreement between the patient's mother and the consultants. She accuses them of abandoning her and they accuse her of emotional blackmail. It went back and forth until the team finally leave saying they should be left alone to practise their medicine as they deem fit. If she (the mother that is) doesn't like it she should go somewher else. We move on to the next lady, the lupus sufferer. She isn't doing too bad and isn't doing great either. We spend a few minutes there and finish off the round shortl afterwards.<br />
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Wednesday consists of rounds around the same patients, less one, with no major development. Thursday sees the addition of one new patient on account of- you guessed it- DKA! Nothing unusual happens today except for the history i took, it was in proper english!<br />
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Friday is the same routine yet again with house officers continually berated. Same pateints are seen, this time the mother of the sickle cell patient is happier and effusive with thanks as her daughter had improved over the past few days. The labs blood culture came back positive when a prior result hadn't yielded anyhthing. The lab used a different technique the second time and grew a pathogen. The young lady was commenced on appropriate anti microbials and seemed to be doing much better. What a difference a few days can make, from being at each others throats to giving and receiving thanks. Life's just funny. As we stand in the corridor a lady and two not so gentle men came along ranting and raving for the death certificate of their mother.<br />
Young man to nurse: 'you short evil witch, you killed my mother. You're evil, so evil'. The doctors try to placate him but their pleadings seemed an incendiary to him. 'You stupid people, you killed my mother, you're all wicked'. He accuses the hospital of neglect and labels all the staff as incompetent. The consultants become incensed by this behaviour and let out a few words of their own. The confrontation ensues until security is called. I walk up to the nurse afterwards to aplogize on their behalf as they were way out of order. She smiles and says i shouldn't worry, i'm a christian she says, didn't Christ suffer more than this. Her answer impressed me a great deal.<br />
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After everything calmed down we head to the surgical ward to do a consult. The consult takes a little time afterwhich another student on the team presents a case to the senior resident. I get roped in to do the abdominal examination which was abslolutely fine until the doctor says to inspect his inguinal region and groin. I do this with some hesitation and stop short of testing for testicular atrophy thank goodness.<br />
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Finally the day ends bringing to an end my 2 week experience in medicine. Now time for surgery, don't think i'll enjoy it half as much as medicine. I drive home by faith in torrential rain looking forward to the weekend.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-88305954429395439192009-07-21T20:34:00.003+02:002012-12-08T21:01:55.808+01:00Back againI'm back finally from the short hiatus. The lazy bug bit me as well as the network problem blog. Over the past week <span class="blsp-spelling-error" id="SPELLING_ERROR_0">i've</span> been able to attend a conference hosted in Abuja by the association of Nigerian physicians in the Americas. It was quite an interesting and enlightening conference. I met so many Nigerian doctors, specialists in their fields from all over the world. What delighted me the more was meeting several medical students like myself. Overall it was encouraging to find that a large number of people are interested in the well being of Nigerians and are indeed taking active steps to improve the standard of health care delivery. Some government officials attended the conference and as usual were full of talk about health sector reforms, it remains to be see if all the talks and plans will result in improvement of the health indices of Nigeria. <br />
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A look at almost every health index shows Nigeria at the bottom or very close to it. The one statistic that is most worrying and is often quoted as an indicator of our failed health system is the maternal mortality rate. Some sources quote it to be as high as 1200 deaths per 100,000 live births. The cause of death in these women have the same incidence rate as in developed countries. The difference is in how they are managed. A pregnant woman in Ireland develops hypertension while pregnant, no qualms. She delivers her baby safely and soon forgets she ever developed the condition. In Nigeria however, a pregnant woman develops hypertension and one may as well say their farewell to her as she would do well to survive the pregnancy. This situation is entirely unacceptable and shows how badly organized the system is. The irony is that <span class="blsp-spelling-error" id="SPELLING_ERROR_1">nigeria</span> has a large number of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">obstetricians</span> and gynaecologists. One wonders what the heck they are doing! A society that lets its mothers die in the most important act they contribute to society is...</div>
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I'll comment more on the proceedings of the conference in the future. For now <span class="blsp-spelling-error" id="SPELLING_ERROR_3">i'm</span> back in the hospital thanks to the nurses who finally 'took back up their tools' and the doctors who shelved their planned strike. I took a history today in pidgin <span class="blsp-spelling-error" id="SPELLING_ERROR_4">english </span>- the local lingo- Was quite interesting trying to communicate words such as palpitation, dizziness, <span class="blsp-spelling-error" id="SPELLING_ERROR_5">dyspnoea</span> among others. I couldn't help but laugh sometimes as i did this. Was a fun challenge to do it! </div>
1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-77830245897046627362009-07-10T00:28:00.003+02:002009-07-10T01:55:33.193+02:00... and the strike continuedDrove into hospital today alongside some crazy drivers, Yes that's what most of the drivers in this city are, crazy. Dodging and weaving through traffic was the norm, cutting in and out of lanes a regular <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">occurrence</span>. Had to avoid several people so many times. I got to the hospital finally only to learn that the strike was still on . Today no nurses were in and those that came only did so to insist that all patients be discharged. I went to the seminar room to join the team in their morning <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">presentations</span>. The seminar room was small and jam packed with people. No air <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">conditioning</span> was available so it was sweltering. Finally the meeting came to an end with me drenched in my sweat.<br /><br />Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_3">UE</span> called me aside and advised me to go somewhere else for the duration of the strike as the hospital was slowly grinding to a halt. We proceeded on a ward round around 4 patients whom were all advised to make <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">arrangements</span> to transfer themselves to another hospital. I conducted a general examination on the Aids patient with really bad bed sores that began to ooze a greenish, foul smelling liquid. His tongue had a black <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">discolouration</span> on it and he had sores all over his mouth. In summary he was <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">really</span> ill! it never ceases to be a sorry sight every time i go in to see him. AIDS is now a real sight to me as evidenced by this patient and no longer a thing in the books. Rounds didn't last long and i soon left for home. Now to look for somewhere else to continue my hospital attachment1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-75460714354593639682009-07-08T23:36:00.002+02:002009-07-09T00:18:59.466+02:00...wednesdayToday was a short day, After my experience yesterday i didn't go in to hospital till 9. Result was i arrived late for an emergency <span class="blsp-spelling-error" id="SPELLING_ERROR_0">consultan</span>t ward round. The consultants weren't scheduled to conduct a ward round today however they had to come in as the news of a nurses strike broke. The nurses went on strike at midnight bringing most activities in the hospital to a halt. Heard a story from someone that a woman was in the height of labour in a delivery suite being urged on by a midwife to push. At the stroke of 12 she left to wash her hands and commence the strike, abandoning the groaning woman in labour. Said she: ' I told you to push hard for a reason before 12 now it's past 12 <span class="blsp-spelling-error" id="SPELLING_ERROR_1">i'm</span> gone on a strike'. Doctors had to be drafted in to do the midwife's job. Same was the case on the wards as the doctors had to take over the duties of the nurses. The team discharged who they could. For those they couldn't, they encouraged the patients' relatives to be involved in the nursing care of their patients. <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Intra</span> venous drugs were discouraged and no new patients were taken in.<br /><br />With the nurses strike most of the activities of the hospital were paralysed. The team now had time to critic my history and give me tips on how to improve my technique of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">interviewing</span> patients. Downside is that patients care suffered and the doctors had to stay in till later than usual. With nothing else to do i left for home today earlier than <span class="blsp-spelling-error" id="SPELLING_ERROR_4">i'd</span> done before.<br /><br />Hopefully the strike ends soon and normality returns. However speaking to several doctors didn't reveal a huge amount of optimism. They indicated that things had been <span class="blsp-spelling-corrected" id="SPELLING_ERROR_5">deteriorating</span> for a while and that indications were that change is far away from the horizon. I feel that it is rather unfortunate that a government would treat its front line health care workers with such disregard and impunity that they have to resort to strikes to gain their attention and force them to effect change. It's bad enough the situation that they have to work in, but with the relatively meagre pay and unfulfilled promises of raises and allowances a poor situation is made worse. Conversely the leaders get paid all their salaries and allowances well before they are due when the only thing they do really is sit and talk. If they talked about how to affect peoples lives positively maybe they'd deserve their fat pay checks, however they talk about laws banning <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">homosexuality</span>, indecent dressing and certain television programs. Seriously! in a country where many people live on less than a dollar a day surely there are more important and pressing matters to address. I don't support any of the <span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">aforementioned</span> vices but a government of many poor people should seek to improve their well being before legislating on how they live. <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">That's</span> my 2 cents!1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-71293777569660293902009-07-08T22:22:00.002+02:002012-12-08T21:02:58.335+01:00Tuesday and wednesdayTuesday the 7th came around and i dragged myself out of bed to get ready for my first hospital consultant ward round at 8 am. I got there on time, not the case for the other members of the team who were vital to the ward round. We waited for everyone to arrive and finally commenced at 9.30 am. Dr UE introduced me to the team, we then proceeded to our first patient.<br />
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Patient A was a schizophrenic who had a myriad of problems that i couldn't quite grasp. The consultant spoke to his mom for a few minutes and ignored them for the rest of the time we were there as he quizzed the residents and house officers about the case. The patient lay asleep on the bed, noticeable on his ankles were bruises from being tied down the last time he was in a hospital. I didn't know that such crude methods were still being used to restrain psychiatric patients. We moved on from patient A to Patient W. Patient W is a patient with HIV that has progressed to AIDS. His CD 4 count was 5! (normal range is 500-1600). He looked really sick and cachexic (thin and emaciated) . Worse still he had a bed sore from lying in bed all day. Dr UE called me around to take a look at the sore. Suffice it to say that it was one of the more disturnbing things i'd ever seen and i've seen quite a number of disturbing things. I am beginning to see that HIV is indeed endemic in Africa.<br />
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What was heart warming though about this patient was that his wife was always by his side and attended to him all the time. I was touched that despite the depths of his awful illness his wife was still loyal to him. We moved on from the AIDS patient to a man with heart failure on a background history of dilated cardiomyopathy. He was recovering well and wanting to go home. The senior registrar directed to come back and take a history from him as well as examine him.<br />
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On to the female ward we went to see a lady who had lupus. This was quite suprising as i was under the impression that Lupus (SLE) was a disease that predominantly affected caucasians. She wasn't doing well and was unresponsive to the treatment regime the team had prescribed. The only treatment that was left was a new and revolutionary drug. In medicine, new and revolutionary usually equals expensive. The drug rituximab cost something like $800 for a course, ouch did i hear you say! i hope she's able to afford it and that it works for her. It will be quite an expensive flop if it doesn't work. From lupus we moved to a young lady with sickle disease. She was unresponsive but not in a coma and had a high grade fever. Her Neuro imaging showed cerebral atrophyand several strokes in her brain from her blood vessels being occluded by the sickled red cells. Her mom was very involoved in her care and gave a few suggestions to the doctors on how best to manage her daughter. I was impresssed with this and thought it was something that should happen more often. The issue that arose with her was trying to get a vein to bleed her of large amounts of her own sickled blood and then infuse her with normal blood. This is called an EBT (exchange blood transfer) The haematology team promised to do what they could to achieve this.<br />
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The ward round was full of jokes and laughs, it was quite interesting and fun to walk around with the team led by the two consultants who looked on the lighter side of things. The last patient that was seen was a lady with resistant hypertension. She was on so many drugs yet het blood pressure was still high. The doctors were at a loss as to the reason for this. All the tests for possible explanations for this phenomenom had come up negative. The round ended in A & E with our HIV patient who was suspected to have meningo-encephalitis. After rounds i went back to the heart failure patient to speak to him. On getting there I discovered to my dismay that he didn't speak english, neither did his brother. We got a nurse to interprete for us. Didn't help our communication much and caused me to end the interview early as i didn't feel much head way was being made. I examined him and could see his heart pulsate from a mile away. His heart sounds were abnormal, suggested that he'd sooner rather than later need a valve replacement. Good luck to him.<br />
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I thanked him, washed my hands and left for home soon afterwards. Was a long day and i needed to get some fresh air and rest.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-38146289466943158892009-07-06T22:18:00.002+02:002012-12-08T21:03:25.312+01:00First day of electiveFinally monday the 6th of july has come around. This day marked the beginning of my 5 week elective in the National hospital Abuja. I woke up brimming with excitement and expectation with a slight dose of uncertainty as to what to expect. I left home with enough time to get to the hospital for 8.30 am. Took a taxi and arrived there within 20 minutes of leaving my home, the hospital turned out to be closer than i expected. I found my way- with the help of a couple of people- to the office of the director of clinical services., where i was expected to report. Emmanuel welcomed me into the office with a cursory greeting. He gave me a letter to pass on to the secretary of clinical medicine, the department to which i had been requested to be attached.<br />
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I proceeded to the aforementioned office only to meet a locked door. As i waited on the secretary, I ran into an aunt of mine whom i hadn't seen in a while. Small world! The secretary finally arrived and took my letter. We chatted for sometime, afterwards he introduced me to the head of the department: Dr UE. He was nice and asked his registrar: Dr F to device a roster for me for the rest of my stay on the elective. He asked what my expectations were and stated what they could provide me. I left with Dr F to the wards to be introduced to the rest of the team. Up until this time i was impressed with the hospital enviroment. It appeared clean and relatively well kept. On reaching the wards i met a house officer (Dr O) in the middle of educating a newly diagnosed diabetic patient. The following conversation took place between us<br />
Dr O: Where you from?<br />
Me: Here<br />
Dr O: I mean where do you go to med school<br />
Me: Dublin<br />
Dr O: Oh ok. What language do you speak there<br />
Me: English<br />
Dr O: Do you still remember our pidgin english?<br />
Me: Of course!<br />
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She then turned to the patient and behan to explain the intricacies of diabetes in Pidgin english. It was quite a feat. Her communication skills were good and her way with the patient admirable. She simplified the concepts for the not so literate patient. I wondered to myself if i would be able to do same if put in the same position. After this patient education episode I met another house officer Dr B. He took me to accident and emergency to see a couple of patients.<br />
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The first A&E patient was a female with diaorrheoa and projectile vomitting. (stay out of her way did i hear you say!) We took blood cultures from her and the doctor instructed her to go pay and take the bloods herself to the lab. This was the first thing that struck me as odd. Asking a patient on intra-venous fluid to pay for and hand in her blood tests herself was harsh to say the least. Little did i know there was worse to come.<br />
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We moved to the next patient who was unresponsive and in pain with neck stiffness and an ear discharge. He looked in a very bad way. Tests came back to say that he was HIV positive. This was the first patient i'd met with HIV and i'm told to brace myself to meet many more. Sad part is that he had 2 wives who probably have the virus as well. to ascertain the aetiology of the patients illness, the doctor needed a scan of the brain which was quite expensive. There was a tussle between the doctors on the nurse on whether the scan should be done before it is paid for. The nurse didn't want it done but the doctor in a show of true concern and altruism, offered to give up a portion of his salary to see the patient have the scan. The hospital eventually agreed to perform the scan before the money is paid. Money was a constant issu in the care of patients through out the day. Nurses refused to clean up patients if relatives didn't have nappies for them. Relatives were sent to go buy drugs, needles and the like. The care was patchy and many times patients were left on their own in pain with no one to attend to them. Privacy was not a priority, patients were left exposed as different people trooped in and out. The casualty department was inefficiently run and the nurses and some of the doctors not the friendliest of people one'll ever meet. I can only guess that they're victims of their situation. Their aggression and impatience only an expression of the fustration they feel working in a harsh enviroment<br />
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While there two victims of road traffic accidents showed up with extensive injuries. An especially unfortunate case was the woman with a 9 month old pregnancy. I sure hope she didn't lose the baby as a result.<br />
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One Case that saddened me was Mr M.S in bed two who went to a hospital where his malaria and renal failure could not be handled properly on being sent to the national hospital results showed he had a creatinine of > 1000 which is associated with an increased mortality. Nothing against him but I think it's unlikely he pulls through. I hope i'm wrong. Back to the HIV patient i mentioned initially, he probably noticed some symptoms but paid them no heed as to do so would put a big dent in his pocket. Now he is quite sick and the outlook isn't looking great.<br />
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I left at the end of the day with a feeling that things could and should be much better. It's such a shame that one's ability to pay determines the outcome and standard of care delivered. In cases where time is of the essence, no soothsayer is needed to tell that morbidity and mortality will only go one way: not down!<br />
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It has to change!1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-52063812932507135262009-07-04T10:30:00.004+02:002012-12-08T21:01:19.191+01:00Back HomeYay! I finally made it back home to my beloved city of Abuja, the capital of Nigeria, the heart of Africa. Well so the sign said that welcomed me to the Nnamdi Azikiwe international airport Abuja. Dr Azikiwe is one of the most distinguished Nigerians to grace the earth, that's a story for another day. Now back on point i'm back home yay! oops said that already.<br />
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The day was long, it began at 4 AM and ended at 10 PM. I was worn out by the end of the day. The flight seemed interminable, flying over your destination to an island and then back is not the most pleasant of experiences. Lufthansa (the airline i took) now apparently fly to Abuja via Malabo. The word 'via' i feel gives a different impression to what actually took place. Flying over the destination of the majority of the passengers to a remote island 90 minutes away and staying there for an hour while same passengers remain on the plane surely cannot count as 'via'! If anything it is a capital offence punishable only by ...<br />
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Enough of giving out, i'm just glad to be home safe and sound. Other than the one turbulent episode that had quite a number of passengers screaming and made me spill a drink all over myself it was a rather uneventful flight.<br />
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Getting off the plane, the hot air slaps me across the face. I expect this so it doesn't quite feel as bad as I remember it 2 years ago. I Proceed to the Nigerian passport queue which moves pretty quickly. I pass without being asked to show a visa or state the purpose of my journey, a rare occurence that really only happens when i come home. It takes forever to get my bags, reason: Nigerians are renowned for two things, First their loud manner and second Their oversized luggage when the travel. Finally my bag comes around on the carousel after this one lady beside me had taken off 16 bags that weighed at least 30kg each. I kid you not they were massive, i lifted some of them with her and wondered what in the world has she got in all those bags. I make my way past customs and finally meet my Dad and two brothers in the arrival hall. I see Neto and Archibong who both look diferent compared to the images of them in my memory. We proceed to the car for a long drive home.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-23205727670378195772009-06-26T14:10:00.003+02:002009-06-26T14:29:08.266+02:00Exams overFinally my exams are over. It took almost a month to complete a total of -wait for it- 6 exams. This brings to a close the longest academic year of my life.<br />The year started in <span class="blsp-spelling-error" id="SPELLING_ERROR_0">september</span> and ended in <span class="blsp-spelling-error" id="SPELLING_ERROR_1">june</span>. Needless to say <span class="blsp-spelling-error" id="SPELLING_ERROR_2">i'm</span> tired, wrecked, jaded, knackered, you name it. The last two exams revealed to me that a <span class="blsp-spelling-corrected" id="SPELLING_ERROR_3">career</span> in <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">ophthalmology</span> or <span class="blsp-spelling-error" id="SPELLING_ERROR_5">otolaryngology</span> is not for me. I can't even spell the latter right!<br />Now my head is turned in the direction of home and my elective in Nigeria, the very reason for this blog.<br />In preparation I got a few summer reads to keep me occupied. The summer for me is usually a time to read materials other than medical books. I bought Jerome <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Groopman's</span> much acclaimed book, 'the anatomy of hope'. Also got <span class="blsp-spelling-error" id="SPELLING_ERROR_7">Chimamanda</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_8">Adichie's</span> new collection of short stories: 'the thing around your neck'. I'm particularly looking forward to reading this as <span class="blsp-spelling-error" id="SPELLING_ERROR_9">chimamanda's</span> previous two books were superb. She's been dubbed a master storyteller by many, least not being the great <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Chinua</span> Achebe. I concur with their sentiments.<br />I've two other books in the post, hopefully they make it on time before i fly home. I'll comment on them when i receive them.<br /><br />Furthermore in preparation I'd been looking up conferences to attend while at home. Fortunately i stumbled upon one organized by the association of Nigerian physicians in the Americas. It had a lot of good speakers including the Nigerian health minister, i hope to attend this and glean as much as i can. I'll write more about the conference in the future. For now I'm celebrating the end of a <span class="blsp-spelling-error" id="SPELLING_ERROR_11">loooooooong</span> year<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_12">Wohoo</span>!!!1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0tag:blogger.com,1999:blog-1722157729907029139.post-44316290690671308462009-06-22T13:31:00.000+02:002009-06-22T13:34:33.399+02:00First postI'm at the end of my third year in medical school, about to go to Nigeria on a five week elective. I hope to chronicle my experience of working in the Nigerian medical system and my thoughts as i go along. I hope it's an enjoyable experience.1k001http://www.blogger.com/profile/12356211243358469619noreply@blogger.com0