Making do in Nigeria

Practising clinical medicine comes with its challenges, especially in settings of limited resources and infrastructure, excessive working hours, and relatively low income. On encountering some of these as an intern in a Nigerian teaching hospital, I wondered how much I could take.

A study in JAMA found that 24 hours without sleep results in psychomotor impairment similar to someone with a blood alcohol concentration over the legal driving limit (2005;29:1104-6). Imagine what that implies for someone who has been at it for a whole month. When I started as a house officer in surgery, I worked in the paediatric surgery unit for a month, which meant that I was on call everyday for a month not having a regular place to sleep. Efficiency is not easy in such conditions. I remember dozing off on one occasion while taking a history from a patient.

Where most facilities are lacking, improvisation becomes the norm to get the job done. Don’t worry if you don’t find a tourniquet, a drip set will do just fine. If you can’t find an inhaler spacer device, look for a cut plastic bottle or if you can’t find a gastrostomy tube, a Foley’s catheter might just help you out. Being able to improvise may come in handy in some wilderness conditions, but alas not everything can be improvised, and the unavailability of some basic medical equipment has denied many patients access to quality health care.

Recently there was a complete failure of water and power supply in my workplace. Though infrequent power and water supply is for the most part regarded as normal in Nigeria, on this particular occasion the hospital generator also broke down and there was no way out. Scheduled surgeries could not be done, patients could not have even the most basic investigations, many patients had to be turned away, and the hospital ground almost to a standstill. Later that night I made my way out of the emergency room with my mobile phone as light source, wondering about the morbidity and mortality that had resulted from all this.

Last year Nigerian doctors embarked on a nationwide strike over pay, saying that doctors were not earning nearly as much as equally ranking professionals in other sectors. One may say: well, it’s not about the money, right? It’s a humanitarian job. Many doctors, however, reason that with the harsh conditions of work and excessive working hours there should be some financial compensation and other incentives. Nigerian doctors feel that they should earn close to the relative incomes of their counterparts in the West. This has caused many doctors to pursue greener pastures abroad and others to leave medical practice entirely.

Recently the government has tried to revive several Nigerian teaching hospitals by renovating and re-equipping them. This has been hailed generally as a step in the right direction. Efforts to improve power and water supply are underway. Primary health care has, however, received little attention. And doctors’ salaries? Hey, maybe some day.

Competing interests: The author is a Nigerian doctor.

Provenance and peer review: Not commissioned; externally peer reviewed.

See “Brain drain and health professionals” (BMJ 2002;324:499-500 doi: 10.1136/bmj.324.7336.499) and “Practicing just medicine in an unjust world” (BMJ 2003;327:1000-1 doi: doi: 10.1136/bmj.327.7422.1000).

       

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