In any case, on Day 6, I participated in the men's triage hall. In the brief time I was there, I saw several cases of presumed gonorrhea and a couple of cases of psychiatric illness. Most of the patient interviews that day (in fact, most days) are conducted in Yoruba, the native language of the predominant ethnic group in Ibadan; the national language in Nigeria in English as a way to unite the country given so many native regional languages exist. Despite that, the consultants and residents I have worked with have been very good about translating the conversations for me. Plus, just by observing, I've been able to pick up on some things such as family members speaking on behalf of the patient (with the patient just sitting there), which in a couple of cases was related to the patient suffering from a psychiatric illness. One other observation - I knew before coming to Nigeria that there was more liberal use of anti-infectives (antibiotics, antimalarials, antifungals) and I certainly have seen that. Lots of pencillins and antimalarials to go around!
From my own practice in clinic in Chicago, I try to take the time to review any imaging (xrays, CT scans) with the patient and to spend a portion of the visit dedicated to explaining why XYZ was happening. Of course, because of all the inefficiencies of things, sometimes this gets placed aside. Since the patients here bring so much of their medical information to each visit (medications (which they call "drugs" here), reports, xrays, family members to corroborate), I have found this perhaps to facilitate a culture and expectation that the physicians spend a good portion of their visits explaining why they have XYZ. As such, patients appeared to be satisfied and empowered in their care. Definitely something I hope to incorporate more when I return to the US.
Later in the day, I learned a little something about "African time". I'm well aware of "Asian time" as my family and I often run on "Asian time" meaning we're late to a lot of things. Plus, working in the Filipino community, I have come to know "Filipino time" too though two of my Filipino American friends who got married last year started their wedding right on time (Eddy and I were 2 minutes late and had to run in before the bride started her processional!). Eddy, on the other hand, doesn't believe in Asian time and has been training me to be more prompt. So yesterday, based on my schedule, I was to participate in afternoon conference/lectures scheduled at 1 PM. I arrived a little early so I could find the location and waited outside the conference room. I waited and waited. And waited. In the end, the lectures started at 2:20 PM with the slow trickle of a critical mass that started about 1:20 PM.
While I was waiting, I met a family medicine senior registrar, Emmanuel, who will be getting married later this month. Our conversation was quite enjoyable and engaging ranging from his upcoming nuptials (his fiancee is a pastor) to palliative care to poverty and health in Nigeria and the US. I appreciated his genuine interest in my perspectives and opinions on Nigeria and he inquired on my thoughts on medicine and life in the US. I hope to run into him again. All in all, I have found that Nigerians are esp welcoming and friendly, taking the time and effort to getting to know you. Often times, they inquire about how I like Nigeria, how I'm adjusting, what I'm eating, if I'm married, if I have children. Perhaps some foreigners may interpret this as a little intrusive but I like it. I feel welcomed. Even walking down the street in the UCH complex or in the hospital itself, strangers will end up greeting me and children will run up to me to say hello.
Having been here for about 1 wk now, I've learned quite a quite about Nigerian and Yoruba culture and customs. Before heading over, I read some websites about expectations such as dressing conservatively, shaking hands to greet, addressing elders by their highest degree (Dr, Professor, etc) and not to use your left hand to accept anything. The dressing conservatively part is easy for me as my fear of malaria lends me to wear pants, socks, clogs and either a long sleeve shirt or layers under my white coat daily (plus DEET lotion too). Shaking hands to greet and doing a modified bowing with a head nod was something I have been accustomed to esp spending time in Taiwan and interacting with elders. It was not an adjustment to use Dr. and Professor as in general life practice, I would err on the side of formality though one noticeable difference is how Nigerians at the same level refer to each other as Dr. The one thing that has been proved to be more challenging is the not to use the left hand to accept things. Do you know how often I use my left hand accept things? Too often! I really need to work on this.
As a pleasant unexpected happening, in the UCH complex, I spoke Chinese! I was on my way to get some Fanta when a middle aged Nigerian man came up to me to ask me if I was Chinese. I replied yes and he responded in excellent Chinese! Whoa... right? The quality and fluency of his Chinese was pretty good and would put some ABCs (American Born Chinese) to shame! He had learned Chinese after living there sometime to do business. He wanted for us to be friends (i.e., he wanted my phone number). In the end, I didn't give him my phone number and he gave me his. Speaking Chinese definitely brought a smile to my face as I encountered something more familiar to me as daily, everything is somewhat unfamiliar and different.
Later in the day, Dayo, as he said, took me to have Chinese food! By Nigerian standards, Chinese food is not inexpensive and there are only 1 or 2 Chinese restaurants in Ibadan. And yes, I did see "my people" there. I saw a couple and their son who presumably run the restaurant. The servers were all Nigerians. I did speak a couple of words to them in Chinese but it didn't go much further than that. This marked the first time I saw a non-African in Nigeria! The is Chinese restaurant was situated in a hotel that was on a hill; before dinner, we took a couple pictures of the view. We even saw another oyibo in the hotel; a true (white man) oyibo.
(I am wearing a lot of clothing to keep the mosquitoes from biting me!)
As to the food, it was okay. We got white sticky rice, stir fry noodles with chicken, Chinese vegetables with Chinese mushrooms and chicken with bamboo shoots (Dayo doesn't eat pork). The most authentic dish had to be the chicken with bamboo shoots and that was the favorite dish for Dayo and I. I want to try dim sum in Lagos as there are more Chinese restaurants there. Nonetheless, it was still nice to eat something a bit more familiar and better yet, I didn't get sick!
Chicken and bamboo shoots
Stir fried noodles with chicken
Chinese veggies with Chinese mushrooms
Before I end, back to the lectures that were suppose to happen. We had a lecture on PTSD (a case of young woman who was abducted and raped by 3 men) and the audience of consultants and residents were very engaged and asked many questions/made comments at the end. I noticed how when they ask questions, they stand and thank the speakers and then ask their question or make a comment. One of the residents facilitated this interaction. We clapped at the end of the presentation too.
Following this lecture, we had a pharmaceutic rep discuss a new malaria agent called Artecxin made of dihydroartemisinin, piperaquine and trimethropim. The key points I extracted from the pharm presentation was that #1 this medication was made in Nigeria (and not China, India or the UK!) #2 that is was affordably priced ($340 Naira for each tab and 8 tabs needed for a course of treatment = 340 Naira x 8 = about $17 USD for a course of treatment) and #3 Nigerian pharma does it like the US pharma - food and beverages and giveaways! Check out the pharma materials that we each received: a nice bag with "roll back malaria", a pen (without any logos), a note pad with pharma marketing and a sample of the medication itself.
Here's a picture of some of the family medicine residents. We sat in the order of rank. The consultants in the very front followed by the senior registrars (senior residents), then the residents, then the house officers and training physicians doing their one year of service to Nigeria.
Other happenings/thoughts/observations:
* I asked a random medical student to direct me to an office. He, of course, helped me and we chatted for a little bit. Later on, he found me at the guesthouse and he'll be organizing an informal get-together with other medical students to dialogue. Sope, see, I'm linking up with students!
* There are few house (intra-hospital) phones. Everyone relies on their cell phone and I have the cell phone number of a couple of head of departments and the chief medical director of UCH. I think when you are on service in the wards, you have a separate cell phone that is passed around. Sometimes, people have more than 1 cell phone for different cell phone providers because cell phone service can be spotty as well.
* On my first day, we tried to buy Diet Coke but the Coke depot (Ibadan has a Coke factory) said they didn't have any. Later on, I discovered that I have to ask for Coca Cola LIGHT, not Diet Coke. On our way to the Chinese restaurant, we picked up a case of Coca Cola Light! Yay!
* Nigerians and the Chinese both talk very loudly, almost angrily, to make a point. At times, I'll see Nigerians raise their voice to make a point (but aren't angry or upset) just like how I raise my voice to make a point when I speak in Mandarin with my parents. Some things are just the same across cultures.
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