Day 13 was the day we left Igbo Ora and returned to Ibadan. Returning to Ibadan was like paradise and plus, Dr. Fasasi (since he had to drive me) and Dr. Sanwo (who is presenting on Friday as well) got to leave early!
Dr. Sanwo was particularly attentive to my eating habits as I had mentioned I enjoyed eating fruits but was concerned about eating fresh fruit in Nigeria after reading all the medical travel advice (boil it, peel it or don't eat it at all!). I tried a cashew fruit (that we had picked off of a tree the day before) which tasted sour and a bit bitter so I didn't eat that.
I then tried to eat another mango but this mango had gone a little bad. Ultimately, I ended up eating Indomie Instant Noodles for breakfast!
I have to admit the instant noodles tasted pretty much like some Asian form of instant noodles with a MSG packet to boot. It's advertised in Nigeria as Tasty Nutrition. Good for you. I think I'm going to pick up some the next time we go grocery shopping and if there is interest to try it in Chicago, I'll bring some home too.
Before we started our drive back, we went into the downtown of Igbo Ora to pick up some local food that cost about $1 USD. I (of course) wasn't able to partake in this. This was the area surrounding the place we purchased food.
I wish I could have taken a picture of the numerous children, women and men surrounded by goats and chickens. (I was refused again). The residents liked to tease me about the goats because the whole time I was there, I could not get over how they roamed everywhere and anywhere including the clinic rooms and even our kitchen. The day before, Dr. Sanwo even had to yell at a goat attempting to enter our kitchen while we cooked.
Our drive back was filled with potholes and we even got pulled over once at a "security checkpoint" that Dr. Fasasi met with exasperation. Still no bribes given. Dr. Sanwo gave me a running commentary of the different types of fruits and spices we saw along the drive. Did you know there was an almond fruit and we basically just eat the seeds in the US? I'll have to try that before leaving.
When I returned to Ibadan, I was relieved and extremely happy as the electricity had been restored!!!! YAY!! When we learned that electricity had been restored the night before leaving (we all had been checking in with people at UCH), we all rejoiced with happiness! It was like being back in luxury. I took a nice long shower with a running tap and sat in my room enjoying the air conditioning.... until of course the electricity went for a bit at night. Of course.
Igbo Ora was an adventure but I'm glad to be back at UCH even with the unreliability of modern conveniences. If I can make it in rural Nigeria, I'm sure you can too.
When I arrived home, everyone that I had become friends with me re-greeted me and welcomed me back either in form of a phone call, text or flash. The oyibo made it out of the bush!
Hello, good morning. It's been almost 36 continuous hours that the UCH complex has been without light. Due to this, the gent (= generator) ran out of diesel yesterday midday and I was initially told that we had no spare fuel and had to wait til Monday. We almost ran out of running water too but luckily there was water in the reservoir to pump into the house. In the end, later at night, we discovered a jug of diesel out back and I was able to sleep in relative coolness and hence post this blog. My grand plan of sleeping in was also thwarted as I received 3 phone calls between the hours of 7 AM to 8 AM yesterday as I learned that Nigerians rise early and sleep late (perhaps the adaptations of little electricity in daily life).
While I was without light during the hottest part of the day, I thought I was going to go bonkers. My laptop and Ipod were out of battery. I was running out of phone credits after calling my husband and it was definitely too hot to take a nap. I even tried reading an internal medicine board review book and my pre-travel papers that discussed warnings and precautions to take in Nigeria (I probably should have read these more in depth before leaving!). I ended up calling Muhammed, a fourth year medical student that I had befriended, to show me where I could buy more phone credits at UCH (because it could get worse without at least one connection to the outside world) and we ended up chatting for a bit in the semi-dark.
I'd love to go into what I learned but it's too far involved and will take too long as I need to let the gent rest (apparently there is gent etiquette). I'm also traveling to a more rural part of Oyo state - Ibgo Ora (Nigeria is divided into states and Ibadan and Ibgo Ora is in Oyo state) from Monday to Wednesday so I'll have to post more about Day 10-13 when I return.
Thanks for all the positive feedback and encouragement and talk soon.
***
I’m back in Ibadan now and it’s like living in luxury! Plus the power is back!!! I’ll write more in the subsequent posts about my adventures in rural Nigeria but back to Day 10.
My personal sense of misery of being hot, in the dark, bored and alone was almost driving me to the point of tears. It just didn’t make any sense how come the power goes out so often and so frequently without any explanation or warning. I’ve now come to learn (and will try to accept) that this is just a fact of life as “this is Nigeria!” Speaking to Muhammed, who is a fourth year (out of 6 years) medical student, was incredibly humbling and definitely put things in perspective.
Muhammed is the oldest of several children and the first in his family to seek post high school education. He will be the first college graduate (and first physician) is his family of modest means. His parents both completed high school. In the preclinical years of medical school (undergrad and med school are combined into 6 years in Nigeria), he was at the University of Ibadan (UI) campus which is about 15 minutes away from UCH. A benefit of being at UI was that during light outages, he could swim in the pool for free and to keep cool. Unfortunately, no free pool is available at UCH to swim in. Because of the frequency and duration of light outages, access to labs (to do chem and bio labs) was limited, tests (i.e. looking at slides of specimens) would be delayed (even to the surprise of the students) and studying was commonly via flashlight.
Here is a picture of Muhammed demonstrating how he might study in the wee hours of night and early hours of morning when it’s cooler. He said he would be almost naked while studying due to the heat and frequent lack of electricity to run a fan.
I showed this picture to a couple of residents and their comment was that even using a flashlight was a luxury and expense – thus, candles are commonly used.
Muhammed and I talked a bit about the path to becoming a physician in the US and he shared with me some of his insight and experiences as a medical student in Nigeria. A few things that struck me:
* As medical students can sometimes get maltreated in the US, he has had experiences when he or another medical student was dismissed from rounds by the senior resident for not being able to answer questions. Unfortunately, this doesn’t foster a nurturing learning environment. I’m not the nicest senior resident but I’ve never dismissed anyone from rounds for not knowing something – this is an opportunity to teach.
* There is a mandatory retirement age in Nigeria of 65 years old. In the medical education world, this means that many elders in the medical field, some of whom have trained elsewhere and returned, are often unavailable to teach and mentor those early in their medical careers. Muhammed described how one of his professors, who trained in the UK, mentioned a physician that would come to work despite being over 90 years of age (This reminded me of a distinguished gastroenterologist where I work at in Chicago that we celebrated his 100 year old birthday last year!). Unfortunately, this was not common in Nigeria at all. Some Nigerian physicians will volunteer their time after this mandatory retirement but from the sounds of it, this is not always a certainty and is only for a specific duration.
* There are many delays in finding post graduate medical training. After one graduates from medical school, there are no guarantees one will find a position as a house officer ( = internship), even those that graduate from the best medical schools such as the University of Ibadan. Who you know seems to play a large role in getting house officer and subsequent residency positions. Plus, if you have the misfortune to be amidst your training when a hospital strike occurs, some will find themselves sitting at home, without salary, up to 6 months in some cases, waiting for the strike to resolve to resume their training. By the time one becomes a consultant (= attending), it could be over 10 years of additional training and waiting post graduation from medical school. Many of the senior residents I have met are nearing 40 years old.
* Medical students don’t have regular access to medical journals. I had brought some extra medical journals I had received in the US which I gave to him and I plan to share my PDF files of journal articles I’ve saved on my computer.
What most impressed me about Muhammed was that despite my assertions that it is challenging for a foreign medical graduate to navigate and complete residency training in the US, he was motivated by the fact that the possibility existed for him to do so. The possibility was enough for him as to him, he and others in different levels of training, face adversity and obstacles that those training in the US have never and will never experience.
I also learned about “flashing” in Nigeria which is when someone calls you, lets it ring once and hangs up. It’s a way to show someone you are thinking of them (without spending the phone credits to speak or text them) or in some cases, a way for someone to call you back and therefore use their phone credits (and not your own) (it costs phone credits to call someone but not to receive calls or texts). While we were chatting, Muhammed’s girlfriend had flashed him a couple of times.
In other things, the insect/cockroach saga continues. Sprayed insecticide on 4 more cockroaches before leaving for Igbo Ora. We had to buy more insecticide.
Also, for those curious, despite the somewhat concerning international reporting of the Nigerian elections, last weekend’s elections were considered fairly peaceful. Let’s hope this continues this coming weekend.
This Saturday, I have to admit, I was pretty lazy. I didn't do any of my dictations (which is on my agenda for tomorrow) and I only managed to handwash 4 pairs of socks. I think I probably spent more time thinking about how I was going to try to get by with the clothing I had brought with me than actually washing the 4 pairs of socks. Yes, I was incredibly unproductive.
I wasn't going to blog tonight but since I have the gent (= generator) on and am among the privileged few that can enjoy both light, the internet and air conditioning right now, I really have no excuse (except perhaps laziness).
Today, everyone was under curfew and was only suppose to leave their homes to validate their voting starting at 8 AM and then to return to vote at 12 PM. Unrestricted movement started at 4 PM. Since there isn't a TV in the guesthouse, I rely on the internet to get my latest news and of course, headlines pertaining to Nigerian elections would talk about the bombings that had occurred the eve and today while the elections were occurring. Reading the online articles about the elections to Nigeria just brought to light how little I knew about Nigeria (and Africa for that matter) before my stay here and just how fascinating on what and why Nigeria is the way it is.
Three of the new friends I made this week visited me today at the guesthouse as they knew that I had no where to go and was living alone in the guesthouse. All three did not vote today but were planning on voting next week for the president. All voiced common themes of hope that the new government would foster effective change. All did not vote today for a variety of reasons including work (there is no absentee voting given the widespread ballot irregularities in the past), feeling unwell and safety (Muhammed's parents were concerned about his safety and didn't want him to travel to the voting poll). Apparently, the presidential and the national assembly elections are not the elections the country is most concerned about regarding violence. It is in fact the governors' election happening on April 23 where most of the concern about violence exists. Election leaders are hoping that once the president is selected, this will help guide voting for the governors of each state. This will be interesting to see how it unfolds.
Invariably, my conversations with Nigerians also somehow loops back to this whole electricity thing. Ayo, a family medicine resident who is from Odun State and did some other work before ending up in medicine, had laughed at me earlier this week when I was gleeful when the electricity returned in the hospital while we were seeing patients in clinic. He had mentioned how as a child, he would yell NEPA Oooo! once the electricity had turned back on. (NEPA = National Electric Power Authority, now known as Power Holding Company of Nigeria). He said that my reaction to the return of electricity (and subsequent air conditioning as I was sweating through my layers of clothing including my white coat) reminded him of that. He also mentioned that given the power goes out at least once daily or indefinitely (up to a week or so in some areas), this joy to have the return of electricity soon abated and became a fact of life.
For me not to have electricity is an inconvenience (i.e. I can't go online to surf the web) and completely temporary but for many others, it is something they have known all their life. It means studying with a flashlight or candles for those not fortunate enough to have a generator or living with dependence on light from generators that are shut off at midnight (as they are at the medical student dorms) to conserve electricity. Tola, another family medicine resident, described times in her childhood when her family would just turn on the gent for 4 hours a day (7 PM to 11 PM) as that was what they could afford (as the gents require gas or diesel to run) just so they could have some light during the night. This also means that many sleep without air conditioning (if they can afford one) let alone fans during hot and humid Nigerian nights. I read an article online about the current Nigerian president's plan to solve this electricity crisis with the goal to have one continuous day (and then one continuous wk, etc) of electricity by December 2012. I do hope this can be achieved sooner with the leadership being elected this month.
In adaptation of the unreliability of electricity, I have learned several things: * When you have power, charge everything that has a battery because you never know when the power will go off or come back. I made this mistake last week and my cell phone went dead and people couldn't get a hold of me and had to send others (or will call others) to come make sure I was okay. * Bring a flashlight (or at least your cell phone) with you when you are roaming the guesthouse just in case the power goes out. I learned today that my Nokia cell phone has a built in flashlight component that is good to help one navigate in the dark and also a great substitute on the wards as a penlight. * Once the electricity turns back on, turn off the gent. This is to conserve the fuel for the gent. If the gent is on when I go to sleep, I have asked the night guard stationed at the guesthouse to turn off the gent and turn back the central power source.
I also learned a bit about what Nigerians do when there isn't any running water as I've learned that some people, at baseline, don't have running water consistently. They might have running water from the tap once a week or so. They live on water from jugs that are filled from a reservoir and they pay $50 naira for day workers to fill and deliver these jugs of water. I also learned that when your toilet doesn't flush (because you don't have running water), there is a way to pour a bucket of water into the toilet to simulate a flush and push all the contents of the toilet down the drain. I was pretty impressed by this and will ask them to show me how this is done.
After learning all this, essentially, the guesthouse I'm staying at is like a 5 star hotel. I have air conditioning, a substantial generator that can support air conditioning, light, internet and the fridge, and for the most part, running water. The new friends I have made have been so kind to offer to show me where they live so I can get a better sense of how Nigerians live.
One common theme I noticed through these different conversations today was the strong faith that they all had, as a Christian or as a Muslim. In Yorubaland (Ibadan is part of Yorubaland where the Yoruba tribe primarily lives), most are either Christian or Muslim. All three of my friends today made reference to how they will pray for Nigeria to be stronger, to soon offer its citizens reliable modern life necessities like electricity and water and lastly, for a robust democracy.
My pictures to share today is the flashlight component of my Nokia cell phone (very useful I have to say) and a small banana I enjoyed today (my first fresh fruit in Nigeria!).
