Although my bug bites on my face weren't extremely red or swollen, every person (literally) I spoke to yesterday made mention of them as they stated the bumps were super obvious with my fair skin. In fact, I had to preface my presentation today so that everyone would just stop asking me about it! The head of the family medicine department even suggested that I get some steroid cream for them so they would fade away. Ayo suggested that I wear my glasses so that it wouldn't be as obvious. Dayo was convinced I got them in the "village" (= Igbo Ora) (no, got them in my room in the guesthouse!). No one really thought it was a mosquito bite because it wasn't itchy and no one really thought they were ant bites (apparently ant bites hurt a lot). In any case, I was relieved it didn't get any worse and was fading. Plus, I didn't wake up with any new insect bites in the meantime.
The presentations were scheduled to start a 1 PM, first Dr. Sanwo and her thesis proposal, then Dr. Fasasi and his thesis proposal and then me. We were told to start when a critical mass (= 2-3 attendings) appeared. I think we started at about 1:45 pM and to give the family medicine residents a chance to get as much feedback as possible from as many attendings as possible who still were trickling in, I started off first. My presentation was brief and via Powerpoint. I shared a bit about my background and medical training including a couple of pictures of Match Day and my med school graduation with Eddy and my family which they liked (one of the questions in the end was what Eddy did for a living).
I discussed my impressions from my clinical experiences (sorting hall, clinics, PEPFAR/HIV/AIDS and Igbo Ora including the rural surgery exposure). My goal was to keep things both positive and constructive as possible I have been truly impressed how they are able to provide the type of health care they are able to despite working under such suboptimal conditions and restrictions. I even got some laughs when I talked about my thoughts on goats in Igbo Ora (they are everywhere!). When I talked about my rural surgery exposure, I could tell that the attendings were a bit alarmed by the poor form demonstrated by the attending surgeon. In fact, at the end, I overheard the head of the department stating that they will be reexamining whether their residents will need to participate in the rural surgery experience as they weren't sure they wanted to expose their residents to that type of mentality and attitude. I was happy that I could have potentially helped the residents with this part of their training as overwhelmingly, in private, the residents voiced little joy and benefit from this component (and had diplomatically voiced these concerns to the higher ups) but little improvement or change had yet to happen.
The last part of my presentation was my observations regarding their clinical practice, medical education and resident culture. I've been fortunate to be part of a residency program that enjoys eating and fosters an environment where I am able to eat lunch during the work day. As I had mentioned before, I rarely saw any resident eat anything during the work day and even later found out from a visiting medical student that some of the residents would be on a verge of passing out from hunger. While here, when I knew that if I didn't eat, I would keel over, I would say I needed to go to the bathroom or even needed to take a medication (i.e. anti-histamine) so that I could sneak away to get a snack. I also mentioned how the residents seemed to lack opportunities to interact on a social level and get to know each other as human beings (as opposed to doctors). The head of the department seemed receptive to this suggestion. With regards to medical education, I spoke about supervision and mentorship which in private some of the residents hoped that change (i.e. increased supervision and mentorship) would become a greater priority, particularly for those earlier in their training.
All in all, I got a lot of good feedback and sentiment from the attendings and residents, some even requesting my Powerpoint presentation to save on their laptop. Ayo made mention how my presentation was different from the ones he had seen before as I didn't include much text, had pictures and didn't read my slides verbatim. This made sense to me after observing the next two presentations which mostly each presenter read from each slide, in part due to nervousness I think.
When I observed the two presentations on senior registrar thesis proposals (a research dissertation must be completed in order to complete their final residency examination requirements), I was struck by the complexity and considerations that need to be taken to complete even the most basic research project. The major problem - money of course. They both had described projects that could have been completed in the US with a little bit a funding but as I learned, there was little funding available to apply for and even basic lab tests needed for their studies posed a significant barrier as who was going to pay for it?
Dr. Sanwo's project was looking at hearing loss in elderly patients. Who was going to pay for a otoscope to look in ears? Who was going to pay for the hearing tests? Dr. Fasasi's project involved looking at the immunization levels of children under the age of 5. This project's had logistical issues as to how to get documentation of vaccinations as there is no registry or uniform charting (shots aren't required to go to school), patients go to different hospitals for vaccinations at different times, caregivers lose or misplace the card with their vaccination history and there was no way blood levels of immunity could be done as someone had mentioned this is not regularly done in Nigeria. What I found out is that many a senior registrar personally fund their own research thesis in order to graduate. Ayo told me that one resident spent 800,000 Naira of his own money (= $5194) to finish his project and graduate. Our required scholarly activity in residency training in US certainly pales in comparison.
While we waited to get started, I took a picture with Dr. Sanwo. After she reviewed the picture we had taken, she said she looked "black" in comparison to me and I looked at her funny and said, "well you are black!" We both bursted out laughing. :)
After the presentations (and after Dr. Sanwo and Dr. Fasasi got a lot of constructive (and some very blunt) feedback), Dr. Sanwo took me shopping to two pretty westernized grocery stores. Now that I knew I liked the Indomie Instant Noodles, I brought a whole bunch to eat while I'm here and to bring back home. I got some Nigerian candies and a couple of Nigerian made bags to bring back to Chicago. Plus, I found oatmeal and Nutella which I had been eating almost daily in Chicago before leaving - it's like I'm at home again! I also brought a can of Progressive soup and guava juice from Lebanon.
I have to tell you, it was so nice to shop somewhere were I recognized some the brands. At the last supermarket we went to, I even saw 5 oyibos (yes, I counted) in the store! I almost thought I was back in the US. The owner of the supermarket was ethnically Indian, raised in England and currently living in Nigeria. At this supermarket, I saw plums, strawberries, frozen corn on the cobb, bell peppers and good ole mushrooms. It struck me how Dr. Sanwo said she had not seen bell peppers or mushrooms before visiting this supermarket in the past as these vegetables are not used in Nigerian cuisine. Since I barely cook in general and couldn't justify paying $5 USD for a pound of mushrooms or $8 USD for two bell peppers (all imported from Holland), I didn't buy the produce but it was just nice to see something familiar. On second thought, I should have brought at least the mushrooms so I could have shown Dr. Sanwo how to cook them and how they tasted since she has never had them before!
Later at night, I went out with Tola and her friend who was in between his medical officer year and starting a surgical residency (debating on whether to stay or leave Nigeria) to eat at Soups and Sauces, a restaurant in the Bodija area of Ibadan. It was nice to get out. Dayo called me and was alarmed that I was still outside of UCH. He told me to eat as quickly as possible and to get home before the 10 PM curfew before elections (it was only 7:30 PM); I felt that I was in high school again!
I've realized a few things about Nigerian food - it always involves a starch or two such as yam or cassava in different forms (i.e. eba, amala, iyan) and/or rice and/or plantains, a protein (i.e. beef, goat, chicken, fish, I rarely see pork), a soup made some local spices and vegetables which I've realized isn't a soup soup (it's more like masala in Indian food) that you dip the starch into, and a sauce which is like a tomato/red pepper based dressing.
Here is a picture of the different soups and sauces.
Here is iyan (pounded yam) and the different proteins. I didn't take a picture of the yellow and white rice.
I got iyan (pounded yam) (I only got 1 portion, Tola got 2 portions and her friend got 3 portions; everyone else finished their iyan except me!), egusi (soup made of grounded plant seeds) with the red sauce and chicken plus a Fanta. Total cost = approx $5.50 USD!
Here's a picture of us before enjoying our food.
Afterwards, we hung out a bit at the guesthouse. I could definitely sense their internal ambivalence and struggle with wanting a better life which was felt to be abroad and whether, should they leave, would they return to Nigeria to help affect change. We talked a bit about the suggestions I had presented earlier in the day and Tola was among the hopeful that small changes could happen perhaps as a result of a foreigner; I had suggested that perhaps the residents could rally together (sort of how residents in my program rallied together when budget cuts and philosophy changes were terrorizing our hospital) for a specific issue and try to affect change within their program. Tola had said that she wanted to feel "empowered" to make change as constantly in their lives, they feel, to date, that they have little power to do so esp with corrupt government and leadership and misspent oil money. I could tell that voting for tomorrow's election for the next president of Nigeria was a big deal and that they hope and pray that their votes will be counted fair and square.
I've really enjoyed making new friends in the family medicine department. They are truly generous, thoughtful, intelligent and broad-minded individuals. I feel badly at times because I know the conditions where I live in Chicago are so much better. I have a ton a respect on how they live and succeed in overcoming daily obstacles that border on ridiculousness. Should they be successful in studying and working abroad, I assured them that there is tons of running water and electricity to go around. They already accomplish so much despite these challenges; imagine what they could do if there was water and electricity to go around?
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