Communication skills

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).

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.

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.

Says he: 'ah na cancer oh! Wetin we go do!'

Patient (replies with some trepidation having heard for the first time she has cancer): whatever you say doctor.

Doctor: we go cut am off.

Patient: ah! Cut am off?

Him: yes na. Abi you day use am for anything!

Where was the cancer I imagine you asking. Well wait for it... it was in her left breast!

GNIB

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!

Back in Dublin

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.

On the left are house officers of the general surgical team and the two females are students just like myself

Hiatus

I 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.

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.

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.

Weekend

It'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.

Back again

I'm back finally from the short hiatus. The lazy bug bit me as well as the network problem blog. Over the past week i've 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.

... and the strike continued

Drove 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 occurrence. 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 presentations. The seminar room was small and jam packed with people. No air conditioning was available so it was sweltering. Finally the meeting came to an end with me drenched in my sweat.

Dr UE 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 arrangements 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 discolouration on it and he had sores all over his mouth. In summary he was really 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 attachment

...wednesday

Today 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 consultant 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 i'm 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. Intra venous drugs were discouraged and no new patients were taken in.

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 interviewing 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 i'd done before.

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 deteriorating 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 homosexuality, 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 aforementioned vices but a government of many poor people should seek to improve their well being before legislating on how they live. That's my 2 cents!

Tuesday and wednesday

Tuesday 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.

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.

First day of elective

Finally 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.

Back Home

Yay! 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.

Exams over

Finally 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.
The year started in september and ended in june. Needless to say i'm tired, wrecked, jaded, knackered, you name it. The last two exams revealed to me that a career in ophthalmology or otolaryngology is not for me. I can't even spell the latter right!
Now my head is turned in the direction of home and my elective in Nigeria, the very reason for this blog.
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 Groopman's much acclaimed book, 'the anatomy of hope'. Also got Chimamanda Adichie's new collection of short stories: 'the thing around your neck'. I'm particularly looking forward to reading this as chimamanda's previous two books were superb. She's been dubbed a master storyteller by many, least not being the great Chinua Achebe. I concur with their sentiments.
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.

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 loooooooong year

Wohoo!!!

First post

I'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.