Day 21: Last Thoughts in Ibadan

My last day in Ibadan was pretty busy as I was trying to understand my new plans in Lagos, participate in GI clinic, go buy local art at a gallery in UCH (what a great find!), pack, drop off cloth for clothes for Eddy and I at the tailor and say goodbye to the new friends I had made.

With regards to plans in Lagos, I have found that Nigerians make plans but often times, they are last minute and I'm often among the last to find out. I trust that the plans will come to fruition (and that I will be informed) and that I will be as comfortable and safe as possible. Going to Lagos is exciting as there are more things to do and buy (I can't wait to shop) and going to Nigeria and not spending much time in Lagos would be a shame. So I have to put my type A tendencies aside accept that it will be taken care of and settled soon.

In the morning, I participated in GI clinic, first with the senior registrar and then the consultant who arrived at about 12 PM. Clinic was to start at 10 AM. What can I say - African time. While there was a delay, I went to the art gallery Ayo had told me about. I had stopped by the day before but the owner wasn't there and I felt that the prices were a bit higher for certain pieces than I thought it should be. When I returned, I discovered that the owner as an oyibo too - Sri Lankan. His parents had immigrated to Nigeria and he grew up in Nigeria and spoke excellent Yoruba. He married a Nigerian (she's a senior registrar in family medicine) and teaches art classes in UCH for children in addition to opening an gallery for local artists to sell their work. I ended up purchases 6 different paintings from several local artists for about 9000 Naira (less than $60 USD). The prices that were quoted the day before were wrong; the owner felt bad. I love purchasing local art pieces from where I've been - our home in Chicago tells a story of our travels. The art is packed away (as I'm waiting for my ride to Lagos) but I'll have to post pictures later.

In GI clinic, we saw 2 patients who were medical students that were found to have chronic hepatitis B infections after routine screening for their clinical years. I was happy to learn that most of their clinical work up and tests for this new diagnosis was free; however, it seemed that the viral load for hepatitis B and subsequent treatment (pegylated interferon that costs 20,000 Naira a MONTH out of pocket) was a significant financial hardship for them and others with hepatitis B. One of the medical students seemed not to understand what it meant to have a chronic hepatitis B infection. His girlfriend hadn't been tested yet and his parents were unaware of his diagnosis. We pressed for him to tell them and to have them test. If they were negative, they could be vaccinated to prevent it.

Hepatitis B is a virus that can be spread through ways in which HIV is transmitted. In Nigeria, these viruses can be transmitted through cultural and tribal rites of passage such as markings on the face (which has fallen out of favor), circumcision within the community under non aseptic conditions, and breaks of skin and poor hygiene. One thing I have noticed about patients in Nigeria is that they feel very comfortable removing their shoes in the clinic rooms and walking around barefoot. I've even seen staff walk around the hospital hallways barefooted.

In any case, this medical student really lacked understanding of his diagnosis and what it really meant. What I thought was cool about the consultant was that he said - "come to my office and ask me questions. I will help you understand, eh?" (Nigerians really like to say ehhh.... ahhh... oh.... uh eh! eh eh! to make a point or to show their emphatic agreement to your statement - I (naturally) have started to do this too)

With the senior registrar, we saw a patient that was a professor of UI and the whole clinic encounter was sir this, sir that. Even when a digital rectal exam was being completed, the resident was "sorry sir" and the patient responded" Thank you" or "E se" (thank you in Yoruba). It must have been the most pleasant DRE dialogue I've heard to date. This professor was referred to the GI clinic for consideration of an endoscopy to look inside his stomach for evidence of pernicious anemia. The clinical data didn't really seem to point to this diagnosis in my opinion. What was interesting about the history taking was that it was assumed that the professor didn't smoke or drink because he was a professor (I said professors in the US do both) and that wasn't professor behavior. Plus, he had no idea what his exact age was. He told me how his mother recollected his birth to him and the events surrounding it. He estimated his age to be late 60s say 68. I also recall this happening for another patient I had seen in Igbo Ora as well.

I learned a bit about what things cost. An EGD to look inside the stomach was about 26000 Naira and another 6000 Naira to biopsy a lesion. CT scan was 20000 Naira but a barium enema (which I think is cheaper than a CT in the US) was 30000 Naira. An abdominal xray was about 3000 Naira and an admission to the hospital for a day was 1000 Naira. It's no wonder patients hangout in the hospital with little studies and tests completed.

The last patient of the day was a middle age woman that was very yellow (jaundiced). I could see it in her eyes, the palms and soles of her hands and feet and her skin had a yellow hue. We could palpate her gallbladder very distinctively. She clearly had a biliary/pancreatic malignancy of some sort and was being admitted for further work up. The consultant estimated her bilirubin (the stuff that causes the yellow) to be in the 20-30s.

After clinic, I had made plans with Stella and Maria to finally get to the tailor to get our matching clothes made. We were going to use Dayo's tailor for Eddy's attire. I had to go today as I was leaving Ibadan and the holiday wknd was starting. Our plans to get this done was even rescheduled for today as the day before, they arrived late and I had to go to lecture. Today, African time still held true. We were suppose to leave at 2 PM and ended leaving at 5 PM. But I was happy to make it to the tailor and I'm getting two dresses again. The tailoring fee was cheaper this time, only $3000 Naira for me. $2500 Naira for Eddy. Dayo and Nathan the medical student now here are going to help make sure I get the completed clothes before I leave Nigeria next Saturday.

Before going to the tailor, we went back to this semi-shady-ish money exchange place. I was pretty happy with the offered conversion rate. Nathan, who is Ghanaian, tried to negotiate a higher rate for himself because he had $100 USD bills and I had $50 USD bills. This was not successful and the owner of the money exchange place said that he was generous with my exchange rate because I'm a woman. I bring this up because even though Nathan is African, he hasn't been to Nigeria before. However, every time I bring up something about making sure Nathan is okay, Dayo and others always say - he's a man and an African, he'll figure it out. What I guess is a predominant thought is that you take care of the women (esp the white woman) and the men are left to figure things out.

Since Nathan is Ghanaian, he had some perspectives on how Ghanaians and Nigerians were different (most in part due to inefficiency and infrastructure issues in Nigeria). In the end, my sense of Nigerians (since I've never been to Ghana) is that they are very use to taking care of themselves. They get no electricity from the government, they use a generator. The government can't provide clean water, they dig their own well and buy drinking water. Nigerians are use providing for themselves and their family. They are very resilient in that sense.

Later that night, I made some pasta with Classico sauce and canned vegetables for Nathan and I ate. He added some beef off the grill (suya) that he purchased at the canteen that was wrapped in newspaper. He said the risk of getting diarrhea was worth eating the meat. Must have been really good.

I met with the new friends I had made here and there throughout the day. I would be remiss to say that there were somethings we hadn't had a chance to do yet and somethings they had been able to share with me (i.e. Christianity). We took a few pictures:

Me and Kemi a Nigerian American medical student from Washington DC


Me, Stella and Maria


Me and Dayo

I'll miss the new friends I've made and I have new appreciation and respect for life in Nigeria (and the US). Ibadan was lovely and I'm glad to have called the guesthouse home but it would have been nice for the guesthouse to have a microwave and/or a TV for future guests. Where I will be staying in Lagos (to be determined at this point) may have a TV which is exciting which means I can watch the royal wedding this week!