Day 10: Still on the Gent *updated*

Hello, good morning. It's been almost 36 continuous hours that the UCH complex has been without light. Due to this, the gent (= generator) ran out of diesel yesterday midday and I was initially told that we had no spare fuel and had to wait til Monday. We almost ran out of running water too but luckily there was water in the reservoir to pump into the house. In the end, later at night, we discovered a jug of diesel out back and I was able to sleep in relative coolness and hence post this blog. My grand plan of sleeping in was also thwarted as I received 3 phone calls between the hours of 7 AM to 8 AM yesterday as I learned that Nigerians rise early and sleep late (perhaps the adaptations of little electricity in daily life).

While I was without light during the hottest part of the day, I thought I was going to go bonkers. My laptop and Ipod were out of battery. I was running out of phone credits after calling my husband and it was definitely too hot to take a nap. I even tried reading an internal medicine board review book and my pre-travel papers that discussed warnings and precautions to take in Nigeria (I probably should have read these more in depth before leaving!). I ended up calling Muhammed, a fourth year medical student that I had befriended, to show me where I could buy more phone credits at UCH (because it could get worse without at least one connection to the outside world) and we ended up chatting for a bit in the semi-dark.

I'd love to go into what I learned but it's too far involved and will take too long as I need to let the gent rest (apparently there is gent etiquette). I'm also traveling to a more rural part of Oyo state - Ibgo Ora (Nigeria is divided into states and Ibadan and Ibgo Ora is in Oyo state) from Monday to Wednesday so I'll have to post more about Day 10-13 when I return.

Thanks for all the positive feedback and encouragement and talk soon.

***

I’m back in Ibadan now and it’s like living in luxury! Plus the power is back!!! I’ll write more in the subsequent posts about my adventures in rural Nigeria but back to Day 10.

My personal sense of misery of being hot, in the dark, bored and alone was almost driving me to the point of tears. It just didn’t make any sense how come the power goes out so often and so frequently without any explanation or warning. I’ve now come to learn (and will try to accept) that this is just a fact of life as “this is Nigeria!” Speaking to Muhammed, who is a fourth year (out of 6 years) medical student, was incredibly humbling and definitely put things in perspective.

Muhammed is the oldest of several children and the first in his family to seek post high school education. He will be the first college graduate (and first physician) is his family of modest means. His parents both completed high school. In the preclinical years of medical school (undergrad and med school are combined into 6 years in Nigeria), he was at the University of Ibadan (UI) campus which is about 15 minutes away from UCH. A benefit of being at UI was that during light outages, he could swim in the pool for free and to keep cool. Unfortunately, no free pool is available at UCH to swim in. Because of the frequency and duration of light outages, access to labs (to do chem and bio labs) was limited, tests (i.e. looking at slides of specimens) would be delayed (even to the surprise of the students) and studying was commonly via flashlight.

Here is a picture of Muhammed demonstrating how he might study in the wee hours of night and early hours of morning when it’s cooler. He said he would be almost naked while studying due to the heat and frequent lack of electricity to run a fan.

I showed this picture to a couple of residents and their comment was that even using a flashlight was a luxury and expense – thus, candles are commonly used.

Muhammed and I talked a bit about the path to becoming a physician in the US and he shared with me some of his insight and experiences as a medical student in Nigeria. A few things that struck me:

* As medical students can sometimes get maltreated in the US, he has had experiences when he or another medical student was dismissed from rounds by the senior resident for not being able to answer questions. Unfortunately, this doesn’t foster a nurturing learning environment. I’m not the nicest senior resident but I’ve never dismissed anyone from rounds for not knowing something – this is an opportunity to teach.

* There is a mandatory retirement age in Nigeria of 65 years old. In the medical education world, this means that many elders in the medical field, some of whom have trained elsewhere and returned, are often unavailable to teach and mentor those early in their medical careers. Muhammed described how one of his professors, who trained in the UK, mentioned a physician that would come to work despite being over 90 years of age (This reminded me of a distinguished gastroenterologist where I work at in Chicago that we celebrated his 100 year old birthday last year!). Unfortunately, this was not common in Nigeria at all. Some Nigerian physicians will volunteer their time after this mandatory retirement but from the sounds of it, this is not always a certainty and is only for a specific duration.

* There are many delays in finding post graduate medical training. After one graduates from medical school, there are no guarantees one will find a position as a house officer ( = internship), even those that graduate from the best medical schools such as the University of Ibadan. Who you know seems to play a large role in getting house officer and subsequent residency positions. Plus, if you have the misfortune to be amidst your training when a hospital strike occurs, some will find themselves sitting at home, without salary, up to 6 months in some cases, waiting for the strike to resolve to resume their training. By the time one becomes a consultant (= attending), it could be over 10 years of additional training and waiting post graduation from medical school. Many of the senior residents I have met are nearing 40 years old.

* Medical students don’t have regular access to medical journals. I had brought some extra medical journals I had received in the US which I gave to him and I plan to share my PDF files of journal articles I’ve saved on my computer.

What most impressed me about Muhammed was that despite my assertions that it is challenging for a foreign medical graduate to navigate and complete residency training in the US, he was motivated by the fact that the possibility existed for him to do so. The possibility was enough for him as to him, he and others in different levels of training, face adversity and obstacles that those training in the US have never and will never experience.

I also learned about “flashing” in Nigeria which is when someone calls you, lets it ring once and hangs up. It’s a way to show someone you are thinking of them (without spending the phone credits to speak or text them) or in some cases, a way for someone to call you back and therefore use their phone credits (and not your own) (it costs phone credits to call someone but not to receive calls or texts). While we were chatting, Muhammed’s girlfriend had flashed him a couple of times.

In other things, the insect/cockroach saga continues. Sprayed insecticide on 4 more cockroaches before leaving for Igbo Ora. We had to buy more insecticide.

Also, for those curious, despite the somewhat concerning international reporting of the Nigerian elections, last weekend’s elections were considered fairly peaceful. Let’s hope this continues this coming weekend.