Day 29: Ward Rounds & Live Catfish!

Day 29 marked my final day of "work" and meant that I was going home really really soon! (Can you tell that I am looking forward to going home?!)

I met in the resident work room a little before 9 AM and the consultant arrived at about 9:15 AM. Not bad. We started rounds relatively promptly considering African time. I was a little confused at first because the "consultant" that had arrived was introduced to me as a senior registrar the day before. As it turns out, he just became a consultant (having passed his exams) in Cardiology.

We rounded on about 16 patients scattered throughout the hospital. We first went to the emergency room wards for both men and women. Unfortunately, while we were seeing two of the male patients, one of the neighboring patients was noticed to be expired (= dead). There were flies landing on the man's body but his body never moved. It looked like he had been dead for a while. I was slightly alarmed given if this had happened in the hospital where I work in Chicago, the nurses/staff would have likely called a code blue/Dr. CART for a cardiac arrest. Here, we just went on with things. The nurse put up a removable room divider to give the patient more privacy (there are no curtains or separate rooms - just one large room filled with 12-15 patients). One of the house officers stepped out of rounds to complete the death examination.

One thing I've noticed both here and in Ibadan is that despite having a Cardiology or Pulmonary or Endocrinology service, by and large, these services are just General Medicine services. They admit any and all medical patients via the ED and occasionally get consulted by other services for specialty specific consultations. I was participating on Cardiology service ward rounds and only maybe about a quarter of the patients had an active cardiology issue. Among those with cardiology issues (this is going to get very medical now) included dilated cardiomyopathy (presumably non-ischemic but none of them had any type of cardiac catherization (it's too expensive and there are no facilities for it available on site), decompensated heart failure, and endomyocardial fibrosis which is a type of restrictive cardiomyopathy common in tropical areas with eosinophilla. Didn't seem like the endomyocardial fibrosis was confirmed with biopsy of heart tissue (as this is commonly done in an interventional manner) but rather diagnosed in a clinical manner. The other types of patients we saw included a man that had not walked in 3 wks (presumably had a neurological lesion but had not had any imaging yet), a man with likely terminal cancer in the abdomen with a large swollen belly of fluid and significant cachexia and a young boy with some type acute leukemia that was languishing. It was not an uplifting morning.

It was still very evident that patients that had little or no money did not get the standards of care though it may be possible that these patients got more care on admission than patients in Ibadan. Not sure about that. It became apparent that patients at least 60 years or older when admitted did not have any costs. Their families had to pay for emergency care if they went through the ED but by and large, the rest of their medical care once they were admitted was free. Glad the Lagos state government it taking care of the seniors. I also learned that one session of hemodialysis costs 40,000 Naira each and every time. They place temporary catheters to do dialysis in the groin and remove them every week. They don't have problems with catheter associated line infections.

Remember how I showed you pictures of the newer hospital ward? Apparently, that is the only hospital ward that appears that way. While seeing the 16 patients, we went into a variety of different hospital wards that were all in different states of cleanliness and modernization. The newer ones were large rooms with 16-20 patients without any curtains. There were fans and screens in the windows. The more run down hospital wards were dingy (and smelly) with some fans and often times, compromised window screens. Unlike Ibadan where all patients had bed nets, virtually all of the patients did not have bednets, definitely placing them at risk of malaria.

The consultant leading rounds, despite his junior status, I could tell had subscribed to the culture of the consultants I've seen in Nigeria thus far. He dictated his notes to the house officers/resident and never washed his hands between the 16 patients. He taught a little bit and even pimped me (not nice to pimp the guest!). I thought he did a nice job telling a gentleman that he likely had incurable cancer and that he should go home (as opposed to stay in the hospital). However, given that his area of specialty is in Cardiology, I thought that he would spend more time teaching cardiology when we came across the more cardiology focused patients. Unfortunately, this was not the case. In some situations, I felt that perhaps the patients were missing out on potential benefits of therapy (i.e. getting a ACE in heart failure as opposed to digoxin). For the residents, I felt bad because they were barely learning anything beyond transcribing the attending's note and his plan. There wasn't much teaching outside of this. We even saw a patient that had a pacemaker for a second degree heart block complicated by the pacemaker pocket infection (I've seen a gazillion of these cases in Chicago) and then had a new one placed and found to have ventricular tachycardia. When I heard about this case, I instantly thought that there was so much to learn and to teach! Sadly, the consultant dictated his plan of getting a EKG, reviewing the EKG and checking a basic metabolic panel. No discussion of what is ventricular tachycardia, who gets it, how to work it up, what to do let alone learning about pacemakers, indications for pacemakers and second degree heart blocks. We never reviewed any EKGs (because the patients with exception to 2 did not have one done) and of course never looked at telemetry because there was none except for one patient that had a transport monitor at his bedside. I was totally unimpressed. When rounds ended, the consultant didn't even address us and walked away. As I said, totally unimpressed.

Though it was nice to finally experience a hospital that had running water and electricity, I could still see that the dysfunctions and lapses in professionalism that was seen in Ibadan still persisted despite the existence of water and power. Whereas in Ibadan I had started to blend in and become part of their community, I was just the visitor that was in Lagos for a brief time asking questions here and there so who knows if my observations are clearly representative of what is actually going on. I also missed out on chart review (= morning report) as it was canceled due to resident meetings. I heard that they used NEJM cases instead of actual cases for these chart reviews.

Later in the day, I finally ate the highly recommended live catfish! Dr. Adekunle took me on a 7 minute walk to a side street near the hospital to pick out a live catfish. You don't actually eat the live catfish but you pick a live catfish, they kill the fish right there and then and then cook it really nice and hot and spicy.

On our way there, I thought I was going to die crossing the street. Literally. Remember those pictures from Day 27 where I was sitting in traffic trying to get to the post office? Well, that was the traffic I encountered while walking to get live catfish. Dr. Adekunle laughed at me and held my hand when we crossed the street on the way back. Yes, I know. I'm a scared oyibo.

Here is the selection of live catfish. They barely moved until of course the owner lady poked at them and then I jumped and yelped (still probably skittish from walking in that traffic).


Here are the two we purchased. One for Dr. Adekunle and one for me. I wasn't sure I could finish one but Dr. Adekunle assured me it wouldn't be a problem. It was 700 Naira per fish. Good deal!


Here is the piping hot and spicy and peppery catfish. The spiciness reminded me of Korean spices. My nose starting running when I was eating the fish. I think Nigerians would like Korean food which I heard isn't really available in Lagos. (If it's not available in Lagos, it's not available in Nigeria.)


I did have a small stomachache the next day (probably because of the spiciness) but it was totally worth it! This was probably my most favorite Nigerian food. I want to have it again in Chicago.

Dayo dropped by from Ibadan and picked up my cell phone and plug adapters. He also dropped off our matching clothes made for Eddy and I. They look very cool! Maybe Eddy will let me post a picture of us wearing them. Now that we have matching clothes, I hope we will get invited to a Nigerian party in Chicago!

It's happening! I'm going home soon!

Day 28: Diabetes Clinic, Pharma & Going Home

Today, I started off the day going to the post office. True to form, the post office had not opened even though it was past 8 AM and a small number of people stood in front of the door to encourage them to open the door. When the office finally open and I made it to a station, the clerk was a bit confused as to why I was buying stamps (?collecting?). I wanted to buy a whole sheet but just couldn't justify spending over $50 USD on stamps I would never use. In the end, I spent a bit over $10 USD for two different types of stamps. In the post office, people were cutting in line in front of me left and right. Given I've been in Nigeria for a while (plus I'm hot and tired after 4 wks away from home), I sort of gently (as gently as an Asian girl can) snapped at a man who was standing really close next to me while I was still doing my transaction. Can I get some personal space when buying my stamps?!

In terms of hospital work today, I learned that the things that were on my schedule weren't going to happen. I was scheduled for Neuro rounds (spoke to the consultant = not happening), Gastro rounds (spoke to the consultant = not happening but there was clinic starting at maybe ?10 AM), and Endo clinic (the consultant's phone was off). I ended up hanging out in the resident work room and chatted with a few senior registrars which coincidentally were all women. They were all very pleasant and we discussed the differences in our training systems and call systems. Unlike in the US, there are no such thing as resident work hours nor limits on the number of patients you take care of or admit in a day. You take care of all the patients that need to be taken care of. A couple of them will be in Chicago early next month for a GI conference so we exchanged info. They wanted to know what to wear (is it windy? is it cold?) and where to shop.

I made my way over to the Endo clinic and found that it was in progress. The consultant was there with 2 training physicians. One training physician took the blood pressure and wrote the follow up appointments on their appointment cards. The other training physician filled out prescriptions and lab sheets. The consultant wrote her own notes which later I discovered included the patient's blood pressure, fasting blood sugar (if diabetic), their medications and her signature. Very abbreviated; occasionally some physical exam findings or a sentence or two about the patient if they had any fresh (= new) complaints.

Overall, I was not too impressed by this consultant as she spent very little time interviewing (and examining) each patient. Plus, our patient encounters were frequently disrupted by other patients, ancillary staff, pharma reps (who ended up staying in the room and assisting, more on this later), a visit by a friend with her friend's 7 month old infant (which she held and cooed with) and of course, a bazillion phone calls. Of course, when a patient's phone rang, the consultant would gently scold the patient for leaving their phone on. At some point, I think we were seeing 2 or 3 patients at one time in the same room. I'm getting tired of these lapses in professionalism.

To give this consultant credit, I could tell that she had been quite industrious and traveled quite a bit at endocrinology conferences to present as her original research posters were hung throughout the patient room. She had been to the US for a 3 month posting as well. She was conducting a trial of vitamin E and another medication for diabetic patients with neuropathy. The training physicians were spending most of their time enrolling these patients in the trial (weighing them, taking BP, waist circumference) while she continued seeing other patients in the same room. I'm not sure if there was even really true informed consent.

Clinically, for the most part, the patient were on appropriate medications for their diabetes and they were very good about checking everyone's blood sugar and blood pressure. However, there was an instance in a patient that had uncontrolled blood pressure and wasn't on a type of blood pressure medication (ACE-inhibitor) that has proven benefit for diabetes. I asked about why the patient wasn't started on this medication and basically learned that there wasn't a really good reason why she wasn't. Before asking the consultant, I had quietly asked the training physician sitting next to me and he knew too that the ACE-inhibitor would be ideal but didn't want to ask as well. Plus for the same patient, the patient's family member astutely asked if potentially her diet could be contributing to the high blood pressure. The consultant said no! Ahh... yes... diet contributes to high blood pressure and this was seriously a miss-managed opportunity.

I could tell there was a strong pharma influence in the way this consultant (and subsequently the training physicians) prescribed medications. They were prescribing high cholesterol medications that even in the US are very expensive (i.e. Crestor, Lipitor) that I have no idea how the patients are going to afford them when slightly inferior but still very good high cholesterol medications that are much more affordable do exist (i.e. simvastatin). Later on, this type of behavior made more sense to me as a pharma rep came to visit and stayed in the clinic room for about 1 hour, providing advice about what medications to write for. Talk about pharma influence left and right and breach of patient confidentiality. When I asked the training physician who this person was (the pharma rep), the training physician said he was the pharma rep and that he was very helpful. I guess when you are short staffed, you need everyone to help. But I'm not sure if this type of help really benefited the patients esp when I am confident most patients can't afford the brand name medications that are being prescribed.

I also learned a bit about the struggles of diabetic patients in Nigeria. Insulin is very costly (40,000 to 50,000 Naira a MONTH) and needs to be refrigerated. Clearly by now, you must understand the challenges with simply refrigerating things with shotty electricity let alone just purchasing the medication itself. Thyroid function tests cost about 8000 Naira and take 2 wks to come back. For those patients that enrolled in the study above, they get free hemoglobin A1cs to measure their glycemic control for the last few months. At least they were able to use hemoglobin A1cs to make clinical decisions. Also, the consultant acknowledged that diabetes should get at least yearly eye exams but admitted that the eye clinic was very backlogged. We also did no foot exams to look for foot ulcers which is a standard of care in the US for diabetics.

The consultant did ask me for feedback and I talked about how consultants in the US see the patients every day on the wards. She seemed incredulous about this and quickly said that this wouldn't work in their system. However, I was taken aback by this as the leadership and some consultants in Ibadan had acknowledged the benefits and necessity of increased supervision by the most senior physician. LASUTH has the luxury of having pretty continuous electricity and running water that is not present at Ibadan. But in speaking to this consultant, I felt that despite this facility improvement, the cultural change in medical education and patient care was likely going to be a much greater challenge in LASUTH than UCH.

After taking a breather from the Endo clinic, I ate lunch (I've learned that I just need to step away if I need to eat) and tried to go to GI clinic which unfortunately was already done. Then I tried to figure out if I could go on ward rounds but discovered that had been completed and according to the resident, "I didn't miss anything." Okay. I guess I'll try tomorrow. I'm suppose to go on consultant Cardiology rounds tomorrow. I must at least see this before I leave.

I tried to walk around to take more pictures.

Here is the Endo clinic.


Here is the makeshift "studio" where I got passport pictures taken to have an ID made the day before. I thought it was very appropriate to get an ID (so ppl would know that I was suppose to be around). However, I'm not sure if I'll get the ID before finishing tomorrow.


Here is the front of the modern diagnostic center. Look how one of the doors is opening? Just after I snapped this photo, a guard came out to interrogate me about why I was taking pictures. Of course.


Here is the empty patient waiting area for the medical outpatient clinics.


Being in Nigeria for this last month has been a personally challenging but gratifying experience. I think I am a better person and physician because of it and I know that I will be much more patient and cost-conscious in my medical practice. I appreciate electricity and water on a whole new level. I feel a lot of sadness for the patients I have seen and for the widespread poverty that is present but I have tremendous hope that Nigeria can and will improve in time. Nigerians have been such a good host in making my trip as comfortable and as pleasant as possible. But I still can not wait to go home!

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.

Day 7: Malaria, Graduate Medical Education and National Health Insurance in Nigeria

Today, I learned a bit about the Nigerian National Health Insurance Scheme (NHIS) that exists. A few citizens including governmental workers are covered by the NHIS that was started in 1999. It provides insurance coverage for visits and subsidized tests/studies and medications. I guess my prior statement that here is no health insurance in Nigeria wasn't entirely correct but it doesn't seem like NHIS isn't particularly comprehensive or inclusive. However, it is a start.

I saw patients today with a training physician that is doing her year of service. We saw lots of osteoarthritis, high blood pressure and diabetes which I definitely felt that I could contribute in a productive way. The trade names were different but there were a lot of patients on amlodipine, lisinopril and HCTZ. There were also a lot patients on methyldopa which we don't use frequently in the US. I had a chance to counsel a gentleman regarding his blood pressure which was high despite being on 3 medications. We discussed exercise vs increasing a medication at this visit which made me feel right at home; in the end, he was like most patients I have in Chicago, he wished to try a trial of exercise and lifestyle modification to see if it improved his blood pressure before increasing his lisinopril. We also saw a patient that basically had reflux disease. Whereas I may lean towards lifestyle modification, it seems that Nigerians, like the Taiwanese where I have done a medical rotation, prefer to leave the doctor with a new medication to treat the issue. I also spent a good amount of time explaining osteoarthritis to patient who desired a medication to treat his arthritis. In the end, I think I was able to convey osteoarthritis as a condition by drawing a metaphor to how cars get older and things start to break down a bit.

We also saw presumed malaria. For me, malaria still has a nice mystique to it given I've only seen it twice before coming to Nigeria and the only people that get it in US are travelers returning from their visits in malaria ridden parts of the world that foolishly decided not to take malaria prophylaxis. Here, it's common. It's like getting a cold. Everyone has had it before and has been treated for it. Everyone that comes in with fever +/- body aches +/- headache and other symptoms was presumed to have malaria. Since cost is a driving force in how and what level of care is obtained, many times, patients are just treated empirically for malaria without a blood smear to look for the parasites in the red blood cells. Patients commonly request this because it's more cost efficient. In the US, a person with malaria is in the ICU! In the afternoon, I stopped by the General Outpatient Practice Laboratory where a technician showed me blood smears and I saw lots and lots of plasmodium parasites which cause malaria. In the NHIS clinic, we saw a patient who had a recent fever and fatigue. We sent her home with some anti-malarials just like I would send someone home with instructions to rest and drink lots of fluids for a cold.

During the whole time in the NHIS clinic, it was apparent that attending supervision may be available but not readily and actively used. In the US, all training physicians that see any and all patients must discuss the case with an attending physician and ultimately, any medical documentation is co-signed by the attending. In some scenarios, the attendings also see and examine the patient but this is not required in all settings. From my time here, I've noticed that though attendings state that they supervise the training physicians, for the most part, it is quite passive. The training physician I worked with this morning didn't staff any of the patients she saw with an attending and the attending didn't see any of the patients that had come to the clinic in the morning. In fact, this training physician elected to make a more conservative medication change as she knew it would be difficult and a bit challenging to locate an attending to discuss any more extreme medication modification. In speaking with more residents, some find this a bit disconcerting as they desire more mentorship, supervision, teaching and guidance in making medical decisions. Today, I was helping a physician with just 1 year of post graduate medical training that was basically seeing patients as an independent practitioner.

I have to admit, though I'm getting use to being in Nigeria, I do miss my husband, family and friends and life at home in Chicago. And just when I'm about to wallow about how I miss the US, I get a surprise visit from some visitors that brighten my day. Today, two very nice women, Stella and Maria, from the breast cancer research lab stopped by the say hello. They extended an invitation for me to visit them in their homes and they discussed how they wanted to me get more cloth to make matching clothes for Eddy and I. Apparently, it is a Nigerian practice for husband and wife to dress in matching fabric to social events, to church and on the weekend when they are off work. When I inquired about this with Dayo, he said "of course, we wear the same fabric to church!". We'll have to see if Eddy will want us to go out wearing the same fabric, let alone Nigerian attire, in Chicago.

I've included some pictures below of UCH. It was a bit of an ordeal to get these pictures taken. I had to ask the security guards who said it was okay and then a woman who was walking around told me I had to stop and then I had to ask the Chief Medical Director (who I had met with earlier in the day) if it was okay. Then I had to trouble the Chief Medical Director to inform the guards that is was okay and then one of the guards followed me around and finally, when I wanted to take a picture of the front gate, I had to speak to the guard supervisor. After all this and prior more minor incidents, I discovered this concern regarding picture taking was because I was a oyibo. There is a concern and fear that oyibos will take pictures and then portray Nigerians in the media and abroad in a poor light. Dayo said that next time we are outside UCH, he will take pictures for me of the traffic and buildings as if I was to try to take pictures, it would most certainly be met with some yelling.

The view walking in.


To the right of the picture above. The same buildings also exist on the left side. Each floor is for something different - surgery, medicine, pediatrics.


The view when you drive or walk into the complex. There is security who write down license plates and on your way out, they have you open the trunk to make sure nothing is in there.