I met Ikenna Obieze last year when I just
started my horsemanship. A tall, brilliant chap
with a tired smile. He always wore that smile,
he told me, to ward off the spirit of aggression
that seemed to threaten his relationship with
people especially, his patients."Excessive work
in a suffocating working environment have a
way of making people angry so, I have to smile
away the anger,"he smiled. I had just started
my obstetrics and gynecology posting when he
was about to Start his neurosurgery posting.
And that same day, in the common room, he
received a text from his girlfriend saying
goodbye to him, breaking up with him.
He showed me that text with hot tears running
down his cheeks. But, he did not cry for long;
he was just starting the second of three ninety
days, 24hours calls. And soon as he showed
me the text, his phone started ringing; some
new accident victims had just been brought into
the hospital. There was no room for petty
emotions or his work would be compromised.
He would have to toss his life away,
immediately, in order to save the sick. Yet, he
too, was sick, only that he could not notice. But
I saw it in his eyes.
That was the day I swore never to become a
surgeon. Or even to do residency in any clinical
field at all. That singular encounter with Dr
Ikenna completely discouraged me. I couldn't
just imagine myself, after the hell of medical
school, writing primaries - a hectic West African
exam that qualifies one for the residency
program, that then leads into years of more
hell, like Ikenna was experiencing.
The program is designed to train would-be
specialist in the different areas of specialization
in medical and surgical practices. It takes on
the average of six years to complete the
program. But, in reality, it takes a lot longer
because, it is designed in such a way that
ninety percent fails the exams, each time it is
conducted."It's relatively, deliberate"an
examiner once told me."It is to ensure that any
would be consultant is properly trained, taken
through the furnace, so that he would be able
to handle a patient's life and the teaching
hospital. It is a holistic training,"he concluded.
That same day, I made up my mind to go for
master in pharmacology instead of residency.
And when I discussed it with my consultant, he
gave me a stern warning."You'll never become
a consultant,"he warned."You'll never be a
CMD, and you will watch your mates leap frog
you in the practice."I just sat there, nodding as
he babbled. In the end I just said"no problem".
My, mind was made up. I wasn't going to be a
slave in the hospital, a prisoner for up to a
decade like Ikenna had chosen. And I was right.
Ikenna's life became more distorted as time
went by. Not because his fiancé had left him
because, as she lamented, he wasn't giving her
enough attention. Not because he was often
seen dosing off at almost every corner of the
hospital because he never had time to sleep at
night. Not because some people started
doubting his sanity; lack of sleep actually
affects our mental health and Ikenna had not
slept adequately for two years now owing to
excessive, overwhelming work load. It was
rather because of what happened in the middle
of his neurosurgery posting. It was on a cold
December monday.
We were watching a premier League match
between Chelsea and liverpool when his phone
rang for the millionth time. It was a patient
calling. A patient that had been previously in
coma and had just recovered. Ikenna, as usual,
ran off for the millionth time.
"It's that patient I told you about, let me go and
empty his urine bag. The nurses won't go close
to him, you know. He is violent and HIV
Positive; they are afraid of getting smeared by
his ever bleeding hand", he said to me in one
breath, as he ran off.
"But, you can't be doing your work and do the
nurses work, too,"I countered.
"Is that what you are considering; of what use
is it to wait for the nurses? In this practice you,
the doctor, is responsible for the patient's life
and if you keep waiting for the non committed
support staff, you'll lose a lot of patients."He
replied in one breath, as usual, and ran off.
The match was nearing the end, when he came
back, so sad and sullen. He had a slight
dressing on his forehead. I noticed it as he
quietly came and sat beside me, dropping his
head to cry.
"That bastered just gave me a needle prick", he
lamented.
I was shocked. That was the first time I knew
what risk faces me daily, in medical practice.
"How did it happen,"I asked, a bit angry that
he didn't take precautions.
He shook his head at me."Of course I took
precautions, Emeka, but as I bent to fix his
catheter, he pulled out his Butterfly cannula and
stuck it on my forehead."
"You should go for Post exposure prophylaxis,
you know,"I proffered.
"I got it covered already"he feebly replied. But,
he was shaken and really scared.
"Who knows.... Just pray for me so I wouldn't
just become infected doing this job."He
resumed watching the match.
"We have to pray for one another,"I said.
I would later have my own encounter with that
kind of hazard three times but, luckily for me,
the patients were not infected. Each has
happened owing to tiredness during my own
surgery posting. After staying awake for three
weeks at a stretch, it was inevitable that I
would injure myself in the process of caring for
my patients. Lack of sleep makes people less
careful and shaky. It stems from over work
which stems from the fact that very few doctors
are left in the country because, majority have
run away from the stifling working conditions in
the country. And work has got heavier and
heavier, as time went by. And again, more
patients are coming in as economic hardship hit
the populace harder and harder.
And just like Ikenna, over sixteen thousand
resident doctors sweat and bleed daily,
spending every second of every day in the
hospital, working to save patients'lives. Often
times you could see it in their faces, the
excessive suffering they go through. Tattered
and hungry, these brave doctors keep the
hospitals ticking and without them, there would
be no teaching hospitals. They are bleeding to
become capable consultants in the future, to
create a better healthy future for the nation. The
Hazzard allowance is five thousand naira.
Greatly unfair. Even for hazards like the ones
both Ikenna and I suffered. Even ones bigger
than ours. But, that's not the major difficulty
these days.
Sadly, they too, are not immune to the difficulty
facing every serious minded intellectual in the
country. The same leadership problems pushing
intellectuals, daily, out of this country to
greener pastures, real greener pastures.
Problems like poor renumeration, not in any way
commiserate with the amount of effort invested
in working for the government.

I read this post from the beginning to the end... And i have the following to say:

1) what you said concerning the residency training is nothing but the bloody truth... Neurosurgery is still better, come to pediatric surgery, where you'll see residents coming out of one theatre, going into another, like zombies, all for 90 days stretch: no rest, no sleep!!! And after how many years, failing and failing those bloody exams, you turn into a scrawny consultant!!!

2) i have also made up my mind NEVER to specialize in any clinical field!! Not because the work-load is much, but it isnt worth it al all... There is no single appreciation, either from the government, or even from the patient's relatives....

3) our salaries are nothing compared to what our counterparts earn overseas... A GP can be paid p to $75000 per annum, hehehe, do the math...

Well, na God go save us shaa... Nice post!!!

Welcome into the world of medical pratice in nigeria, you take a seat by the left.

Did they force u to go into dt profesion? Think of what life wil be like if all of us are to study medicine. As a biotechnologist, I was colecting 5k naira as stipend frm d state govt while medical docs were being paid 100k naira during my NYSC days. I dreamed of studying medicine bt i couldn't fulfil it cos i had to find a way to survive -- taking part-time jobs while studying a full-time course. Will u or ur govt nw tell me dt i'm inferior to u in term of academic capability? U seem to easily forget such things like tragic ironies -- especially those dt are divinely orchestrated.

A masterpiece of pure fiction, composed deceive
those who do not have first hand knowledge of
the hospital setting! let me tackle you head on.


1) you work and school at the same time, you
are sponsored by the government, and
remunerated accordingly ( how much is your call
duty allowances compared to that of other
health workers?) when you become consultants,
you earn well. do you expect all to come on a
platter of gold?.


2) No nurse will refuse to empty the urine bag
of a patient because of fear. (this was a lame
attempt to disregard nurses) if it actually
happened, then it becomes a disciplinary issue,
you should have taken it up with the hospital
management, and the nurse will be dealth with
accordingly. nurses are accustomed to doing the
"dirty job" in the hospital....it is actually
unbelievable that a doctor Droped his pride and
ego to touch a urine bag! any nurse in the house
would understand what I'm saying.


3) on the issue of hazard, we are all exposed!
but the most exposed of all are the nurses! at
least you have time to sit in your ARD lounge to
watch soccer. the nurse is inside the ward, by
the patients bed side all through her shift. she
inhales, touches, and contacts everything the
patient brings out! take a look at the ebola
mortality statistics, who is worst hit? it had been
3 nurses and 1 doctor. I remember 2years ago,
after attending to a badly wounded victim, and
having his blood all over my body, his test
results came out, he was HIV positive! I emptied
a full bottle of jik on myself that day, and did
HIV tests monthly for a whole year! ask any
nurse you know, they have a story to tell. 5k is
small for all the hazard, if it should be
increased, it should be done across board.


4) saying that the resident doctor is usually the
first to make contact with a patient is a direct
misinformation! what about the medical record
officer that issues cards? or the OPD nurses that
registers the client and take vital signs? when a
patient is rushed to the a&e unit, who gets to
the patient first? when a patient is admitted to
the ward, who receives him? THE NURSE!


5) Registras do everybody's work? doctors are
overwhelmed? well it is partly so because you
made it so. when you prevent a midwife from
examining a pregnant woman, delivering a baby,
the gyneacologist is bound to overwork himself!
when you refuse to allow a registered nurse do
physical examination, or pass iv line, she ll wake
you at 2 a.m to do it. when you refuse to allow
the lab scientist to do his work, you are bound
to outdo yourselves. when you reduced a
pharmacist to a dispenser, you thought you
were doing yourself a favour!


6) appointing other healthworkers as consultants
in their own fields does not affect the chain of
command in any way! A consultant pharmacist is
restricted to "pharmacy" that's his specialty, he
ll work within his scope of knowledge and
experience. he has no right to alter a doctors
prescription. if he does, then it is a disciplinary
issue period! He should offer suggestion to the
medical consultant, who makes the final
decision. please get that right.


7) if you think a nurse is going to arrange
instruments for you to do your wound dressing,
then please go back to your private hospitals
and order your auxiliaries around. if you were
taught asepsis, then you should know how you
ought to get your instruments.


refering to core members of the health team
as "suport staff" and paramedics, is the height
of your pride and ignorance. please Google the
term "para medics" and "hospital suport staff "


9) other members of the health team are not
jealous, they are just fed up with the oppression
and prejudice in the system.


10) please identify any of the 24 demands of
NMA that has anything to do with improving
healthcare delivery in nigeria

Rubbish!!!

@theplanmaker...

Please stop spreading lies!!!

Residents are not sponsored by the government...

Its the house officers that come in contact with patients first, not nurses

imagine a surgeon exposed to all sorts of hazards, and you're telling me nurses are exposed to hazards...

If doctors watch soccer in the common rooms, then nurses also watch african magic in the wards!!!

How many times will i say this: being a consultantin any medical field is not an appointment... You have to write exams, and even fail them in nigeria!!! Come on, its even all over the world!!!

If you hate doctors, please travel out and establish your nursing home...

He even said pharmacists are hospital dispensers... Your mates are working in evans, gsk, NGC... You are here blabbing!!!

Abbbegggiii!!!

This epistle is making me have a re-think... God help us!

theplanmaker: A masterpiece of pure fiction, composed deceive
those who do not have first hand knowledge of
the hospital setting! let me tackle you head on.
1) you work and school at the same time, you
are sponsored by the government, and
remunerated accordingly ( how much is your call
duty allowances compared to that of other
health workers?) when you become consultants,
you earn well. do you expect all to come on a
platter of gold?.
2) No nurse will refuse to empty the urine bag
of a patient because of fear. (this was a lame
attempt to disregard nurses) if it actually
happened, then it becomes a disciplinary issue,
you should have taken it up with the hospital
management, and the nurse will be dealth with
accordingly. nurses are accustomed to doing the
"dirty job" in the hospital....it is actually
unbelievable that a doctor Droped his pride and
ego to touch a urine bag! any nurse in the house
would understand what I'm saying.
3) on the issue of hazard, we are all exposed!
but the most exposed of all are the nurses! at
least you have time to sit in your ARD lounge to
watch soccer. the nurse is inside the ward, by
the patients bed side all through her shift. she
inhales, touches, and contacts everything the
patient brings out! take a look at the ebola
mortality statistics, who is worst hit? it had been
3 nurses and 1 doctor. I remember 2years ago,
after attending to a badly wounded victim, and
having his blood all over my body, his test
results came out, he was HIV positive! I emptied
a full bottle of jik on myself that day, and did
HIV tests monthly for a whole year! ask any
nurse you know, they have a story to tell. 5k is
small for all the hazard, if it should be
increased, it should be done across board.
4) saying that the resident doctor is usually the
first to make contact with a patient is a direct
misinformation! what about the medical record
officer that issues cards? or the OPD nurses that
registers the client and take vital signs? when a
patient is rushed to the a&e unit, who gets to
the patient first? when a patient is admitted to
the ward, who receives him? THE NURSE!
5) Registras do everybody's work? doctors are
overwhelmed? well it is partly so because you
made it so. when you prevent a midwife from
examining a pregnant woman, delivering a baby,
the gyneacologist is bound to overwork himself!
when you refuse to allow a registered nurse do
physical examination, or pass iv line, she ll wake
you at 2 a.m to do it. when you refuse to allow
the lab scientist to do his work, you are bound
to outdo yourselves. when you reduced a
pharmacist to a dispenser, you thought you
were doing yourself a favour!
6) appointing other healthworkers as consultants
in their own fields does not affect the chain of
command in any way! A consultant pharmacist is
restricted to "pharmacy" that's his specialty, he
ll work within his scope of knowledge and
experience. he has no right to alter a doctors
prescription. if he does, then it is a disciplinary
issue period! He should offer suggestion to the
medical consultant, who makes the final
decision. please get that right.
7) if you think a nurse is going to arrange
instruments for you to do your wound dressing,
then please go back to your private hospitals
and order your auxiliaries around. if you were
taught asepsis, then you should know how you
ought to get your instruments.
refering to core members of the health team
as "suport staff" and paramedics, is the height
of your pride and ignorance. please Google the
term "para medics" and "hospital suport staff "
9) other members of the health team are not
jealous, they are just fed up with the oppression
and prejudice in the system.
10) please identify any of the 24 demands of
NMA that has anything to do with improving
healthcare delivery in nigeria

I embolden the statement because it just confirmed what the op wrote. When a nurse thinks it is beneath him or her to arrange an instrument tray it speaks volumes.
I had an expirience when we had a visiting consultant from the UK, I was assisting him gown and glove and our nurses took offense that it was their job and I was making them look bad. That was amusing to me because for the last 7 years I worked with them they never knew it was their job but now because it was a white surgeon they suddenly remembered.
Presently I don't care if nurses come with me for a ward round or not, what 10 years ago nurses did for me, my residents now do including removing stitches and wound dressings because the nurses nowadays are too big for such jobs. I send my residents to give IV drugs because nurses are too big to do that even when there is a line already.
The residents and house officers now do the jobs of records staff( holding on to case notes so they don't dissapear), laboratory scientists (doing investigations in side labs because results from the lab may take days to come out even when you say it is an emergency) porter (personally wheeling patients to theatre, taking blood samples to labs and collectting results even collecting blood for transfusion from the labs themselves) nurses, setting instrument trays, wound dressings, taking vital signs, monitoring urine input and output.
Fortunately for me I have passed that stage and I tell my residents to do anything it takes to get the patient better, it also pays them because when they open their own clinics in future they have a better understanding of how each person on their team does his job.

Please someone should government to recall residents oooooo. I can't imagine myself surviving with the paltry sum idola hospital pay me ooooo.