Here is me (in the more formal dress but you can only see the top) and the tailor. He took pictures of me with his cell phone. He says “oyibo” with such joy!
Here is me adjusting the traditional headpiece called the gele. The tailor’s assistants helped place this on my head.
And now here’s the oyibo wearing the gele in the shorter, casual dress. I think I might be able to wear this dress in my regular life in Chicago with a nice cardigan – what do you think? If you think I look like I'm sweating it is because I was sweating a lot. Nigeria's heat is pretty brutal.
On our way to pick up the dresses from the tailor, we got stuck in quite a bit of traffic because tomorrow, there is a nationwide curfew from 8 am to 4 pm for the upcoming elections. Tomorrow, Nigerians will be voting to elect the national assembly and everyone was out and about to do last minute errands. Reading online news outlets, I can see that the violence that has been occurring in Nigeria has been receiving some coverage. I’m a little concerned but I feel confident that I’m safe in the UCH complex with guards at the gate and at my front door. Plus, with the new friends I’ve made, they will be stopping by tomorrow to say hi so at least I won’t be alone!
Dayo took all of these pictures of Ibadan city life for me as it not really feasible for me to take them without drawing some unwanted, negative attention. Note the traffic jam and the plethora of men selling a variety of things. Today, I saw a man selling a globe and sponges… you know… just in case while driving you wanted to pick up a globe or sponge to do dishes that night!
Before coming to Nigeria, I asked about animals because when you think of Africa (before you’ve visited Africa) what comes to mind is the animals, like giraffes, tigers, lions, hippos, wandering around in their natural habitat. Sadly, my dreams of going on a safari are on hold as I was told by Sope that “we (Nigerians) ate them all!” I was challenged to take pictures of any animals that weren’t rodents/insects, animals raised as pets or in a zoo or animals raised to be eaten. So far, Sope has been right and I haven’t seen any wild animals besides insects and lizards. Nonetheless, I wanted to share a couple of photos of animals I saw today when running errands in Ibadan.
Here is a pregnant goat, just walking down the street…
Here is a sad, skinny cow. This cow did not seem too happy. As I seemed excited to have a picture of this cow, Dayo asked me if we had cows in US. I said the cows I've seen are whiter and fatter.
In terms of hospital stuff today, I was scheduled to attend HIV/AIDS consultation service ward rounds at about 8 AM but due to Nigerian time, we started a bit after 9 AM. Luckily, this afforded me the time to chat a bit with another family medicine resident who shared some insight about the prison conditions in Nigeria as he was going to see 7 prisoners with HIV/AIDS and bring them their HIV medications. He or another resident go to the prison monthly to see these patients.
What I learned about the Nigerian penal system is that it is troubled with human rights violations - terrible prison conditions; poor health and nutrition; imprisonment for who-knows-how long before trial; serving the sentence that you end up receiving before you go to trial and then having to spend that additional time incarcerated or worse yet, spending significant time incarcerated waiting for your trial but only found to be innocent. Illegal drug dealing or use wasn’t a common crime as much as theft and armed theft which falls in line with the struggles with poverty. Also, when a crime occurs and is reported, the police won’t simply come to investigate; they will come to arrest everyone, hold them and interrogate them one by one. Seems like a situation where you can definitely be at the wrong place at the wrong time.
On the consultation service ward rounds, we saw 3 patients on medicine services that also had HIV/AIDS. The first case was incredibly sad as this was a 50 some year old man with AIDS that had presented with ring enhancing, space occupying lesions of the brain with altered mental status. He had been there for over 50 days and the physicians were still not sure what had afflicted him (toxoplasmosis, metastatic tumor lesions, or even possibly tuberculosis) despite receiving some treatment. Unfortunately, his care had been slowed to a snails crawl as his family no longer had the means to fund his care. When we saw him, he was obtunded and non-responsive with his limbs contracted with evidence of significant temporal and generalized wasting. I could sense and see the hope this man’s wife who sat dutifully at his bedside. To communicate to the primary service, we wrote a note in the chart (which seems to be the practice as opposed to calling the team) recommending at head CT (and advice to seek access to the indigent fund to pay for the head Ct) to help guide prognosis and conversations with the family regarding care. Later on, in discussing this case with Dr. Adetunji, who was the consultant today, we both admitted that palliative care/hospice would likely be on the horizon should there be no sudden improvement in clinical status or new funds to pay for extensive continued medical care. And like the challenges with palliative care/hospice that we have in the US, Nigeria too struggles with it as well.
During these rounds, we also saw patients that had or likely had tuberculosis (TB). In the US, TB is treated very cautiously in the sense that pts with possible TB are isolated in their own room with negative pressure and visitors are suppose to wear masks to prevent exposure. Here, TB patients are scattered throughout the hospital wards without any separation besides drapes and generally without anyone wearing masks of any sort. Of course, I was distressed by this as I’m TB naïve and my PPD (that thing you get placed on your forearm to see if you have been exposed to TB) is still negative. My distress became very obvious to the rest of the medical team as the patients we saw and the patients that surrounded us coughed and coughed and coughed. To get TB, close quarters of a significant duration with a person with active TB aerosolizing the bacteria by cough is what drives transmission. As the hospital wards are airy (all the windows and doors open with air flow in and around in a large room filled with about 20 patients) and I am healthy with an intact immune system (as opposed to HIV patients), I am hoping my potential exposures will not result in acute or latent TB. I’m keeping my fingers crossed.
A few other things I learned/noticed:
* Family medicine takes care of the HIV/AIDS patients because when the PEPFAR clinic was started, no one else wanted to take care of them.
* Family medicine had to fight to have the HIV/AIDS patients not isolated on one hospital ward to reduce stigmization. Although much progress has been made already, the family physicians still get a sense that care for patients with HIV/AIDS is still stigmized (and perhaps of lesser quality) by other health care providers.
* In rounds, we didn’t refer to the patients as having HIV/AIDS. We called them “known retroviral or PEPFAR patients” as a way to preserve patient confidentiality on the hospital wards where up to 20 patients were housed in one large room only separated by curtains. (When the opportunity presents itself, I will have to try to take a picture of the hospital ward to better illustrate this.)
* The World Health Organization recommends that HAART (HIV meds) be started once the CD4 drops less than 350. Based on their financial constraints, this PEPFAR clinic starts HAART once the CD4 drops less than 200. Despite these challenges, they are still doing wonderful important work.
* Antibiotic coverage for MRSA (a type of Staph aureus that is resistant to pencillins commonly found on the skin and plagues US hospitals) is not commonly used or available (no vancomycin for everyone!). In fact, I got the sense that MRSA wasn’t really studied or treated all that often.
I will spend a total of 2 wks with the family medicine department before moving on to the internal medicine department for my last 2 wks. I'm no longer going to Lagos for 2 wks as it seems the strike won't be ending any time soon. Even though my specialty is internal medicine, I feel a strong sense of kinship with the family medicine physicians here as they are the ones that truly provide primary and community health care in Nigeria which is what I hope to do longterm post residency. Despite whatever financial and environmental (i.e. water, electricity) constraints that exist for them on a daily basis, I am very much impressed by the work they are able to do.
I hope to sleep in tomorrow and try to do some laundry by hand (primarily socks because I brought enough underwear for the whole trip!). Tola, a friend from the family medicine program, will be visiting me for lunch and I hope to finish up and sign my clinic dictations from Chicago (yes, work goes on even when I'm away!). And yes, I plan to stay indoors while the elections are happening.
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