Day 27: Grand Rounds, New Perspectives, Election Update & Traffic

Today was my first full day at LASUTH. It started the way I had anticipated - waiting and more waiting but with lots of pleasant conversation. By now, I'm accustomed to African time and making adjustments to it. To be fair, my posting at LASUTH was arranged at the last minute and the hosts have been nothing but accommodating and hospitable.

In the morning, I met with Dr. Bode who had 3 different Nigerian newspapers with him. He said it was okay for me to take pictures. Here are the headlines:



Yes, there are underage boys voting and gunmen snatching ballot boxes but still more peaceful and transparent than before.

Here is the president-elected and governor elected of Lagos, both winning reelection. Their pictures hang in many people's offices and building just like I've seen at VA hospitals in the US and everywhere in Asia.

Dr. Adekunle stopped by to say hello and gave me a quick tour. Since he is a dentist (and has worked in the US in mental health and dentistry), he paid special attention in showing me the dental facilities which were quite nice and in a new building. Dental care (compared to the US) is relatively more affordable (1500 Naira = $10 USD for a dental cleaning) but no type of insurance coverage. Everything is out of pocket. Dr. Bode is an orthodontist. They tell me a few Nigerians get orthodontics done. Dr. Adekunle commented on how my teeth looked pretty good (I had braces over 15 years ago). My orthodontist would be proud.

Here is a newly built hospital ward at LASUTH. About 2-3 years old. There are 5 semi-large rooms to house 4 patients and there is 1 private room with air conditioning. The other rooms have 4 fans and running water. I asked how frequently they had running water. The nurses said all the time. The other rooms are for equipment, family waiting room, and physician and nurses work stations. The patient bathrooms are at the end of the hallway.

On the way to the wards.


A pod for 4 patients.


We also walked through the Surgical Emergency room. Unlike the Medical Emergency room, when you walk in, there is a sign that lists the consultant in charge and his phone number. Ventilation here was again poor despite some air conditioning. There were gurneys throughout the hallways. Many of the patients were men, likely from road vehicle accidents, many with lacerations to the head.

We toured a mini-ICU and there was a patient on a ventilator and there were actual functioning monitors. Three of them to be exact! When the I heard the sound that the ventilator makes when the patient breathes over the ventilator, I finally heard something familiar!

Here is an ambulance. In theory, if you call 767, an ambulance come to you. These are use to transport patients within the hospital complex from the ward/emergency room to the CT/MRI scanner in the super new modern building.

I met with the head of the medicine department as she was finishing her dermatology clinic. Her last patient was an albino. During my month long stay here, I've seen a handful of albinos who have pure white skin throughout. This patient had the unfortunate circumstance to have a huge, fungating ulcer on his lip that was likely some type of skin cancer. The patient allowed the consultant to take a digital photograph but then promptly covered his mouth with a handkerchief. Even after we all had seen the lesion, he kept the handkerchief over his mouth while trying to take something out of his bag to give us. It was quite disfiguring and must be very distressing for him. I learned that albinos, unlike those with vitiligo (just patches of white skin), tended to feel proud of their white skin color and many do not adopt habits to protect their skin from sun damage like hats, sunglasses and long sleeves, let alone sunscreen.

After we finished seeing this patient, the head of the department tried to arrange my schedule for the next few days. This all seemed very well intentioned but took a bit of time to locate the ward rounding schedule (consultants only round 1-2x/wk per unit and on different days per unit) and the specialty and general clinic schedule. Apparently, the specialty clinics rotate in being a "general medicine" clinic daily; this happens in Ibadan as well. There is family medicine at LASUTH and they refer to the medical clinics when they think some type of specialty care is needed.

I asked about the health coverage Lagos State extends to their constituents. Apparently, one must apply to get health coverage from the state government and from the way it was explained to me, it helped if you knew someone in the government or had some special relationship. Also, the National Health Insurance Scheme (NHIS) is apparently available to more than just civil employees but no one could really explain how one could apply or how the insurance provided coverage. Also, I learned that an predominant thought among Nigerians is that to get sick is to have wronged your neighbor. With this belief, to preach prevention, early detection and insurance might be naught.

Patients that come to Lagos State, without family at bedside, can get some basic services and labs and maybe an chest xray. How they were able to extend care to those financially strapped wasn't well detailed but I was assured that some degree of care was provided. In fact, the chief medical director cited at 2 million Naira fund for this purpose but I wonder how quickly it is depleted. Later on, in speaking to a resident in private, she admitted that those without family to help pay would get very basic care but no medications, no complex labs beyond maybe as a blood sugar or PCV and not really any imaging. I am getting a sense that perhaps in actuality the reality is less rosier than they are making it out to be but I am told the state of LASUTH and health care for Lagoians is by far better than it was 5-10 years ago. That is progress.

For lunch, I ate at Sweet Sensations which is a chain fast food joint that primarily serves local Nigerian food. It's a clean place to eat and it's in the hospital complex.

Here's what I had for about $7 USD.


Plantains, seasoned chicken breast/wing and Jollof rice. The Jollof rice is a bit spicy to my liking.

At 1 PM, I arrived to their conference room for grand rounds which was on a gastroenterology topic. To my surprise (and delight), we started only 30 minutes behind schedule! During the presentation, the power went out 3 times (with subsequent turning on of the gent). The presentation just continued without a pause! In fact, the residents generally can't tell when they are on the gent or getting power from NEPA because the same amount of light is present. This is unlike UCH where if we were on gent, only the emergency lights would be on, the ACs would be off and the sockets were all dead. At LASUTH, irregardless of who is supplying the power, the sockets work and the AC can be on full blast.

Anyways, I digress. I was pretty impressed by the organization and clarity of the presentations. More organized, less reading from slides. Appropriate and non-attacking questions by the audience. The residents were backed up by their consultant. The topic was irritable bowel disease which is more common in Nigeria that everyone had originally thought (most thing changes in bowel habits here are either malaria or typhoid). Afterwards, we had a brief pharma presentation for an anti-platelet agent. Yes, we got pens and free food and drinks.

I appreciated how the Cardiology and Dermatology consultants were inquisitive and seemed committed to retaining some of their skills as a general internist (as they have to see general medicine clinic as well). What struck me here and in UCH was that the number of consultants were very low. Only 2 to 3 consultants per subspecialty. I noticed this as well in Ibadan. I heard from the residents that consultant jobs are hard to find as well after graduation from residency. Seems to be a funding problem in paying for their salaries. Definitely short staffed for the volume of patients that need to be seen.

Afterwards, I saw a resident call room. It had AC and a cot and table. The residents bring their own sheets when they are on call. The senior registrar can stay in house if they wish but many just go home when they are on call. The registrars and house officers will call them if needed. Another thing I noted was that half of the internal medicine program at LASUTH was composed of women and one of the women was expecting later this year. Not sure why UCH had so few women in internal medicine in contrast.

After work, I wanted to go to the post office to get my mom some stamps. (We like to collect stamps from throughout the world; a little nerdy I know.) This is the traffic while we tried to get to the post office which in theory was less than 3 minutes away on under ideal driving conditions.

To my left.


To my right.


Straight ahead and our poor driver, Abudu. He can't really understand my English very well.


Lagos traffic craziness.

In the end, the post office was closed. Only open from 8 AM to 2:30 PM. Guess I will have to try tomorrow morning before work.