Adepero Ajayi – Medical Elective – Lagoon Hospital, Apapa, Nigeria Wumi Oworu – Medical Elective – University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria Abiola Adeogun – Medical Elective – Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Name: Abiola Adeogun
Country of study: United Kingdom
Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Elective Period: 28/03/16 – 22/04/16
Duration of Elective: 4 weeks
Speciality: Cardiology, Diabetes and Endocrine, Neurology and Respiratory Medicine
A typical week included attending ward rounds and clinics attending occasional teaching with the doctors.
- What 3 things did you learn?
1) Making a diagnosis without relying on e.g. imaging and test results.
2) Management of tropical diseases.
3) The structure of the healthcare system in Nigeria.
- What were your most enjoyable moments during your elective?
Being able to go to theatre.
- What similarities and differences did you notice whilst on your elective in Nigeria, in comparison to the healthcare service you have witness whilst at medical school?
Differences in doctor patient relationship, communications skills, organisation and resources.
- What were your goals? Where you able to achieve your goals, and how?
To have a better understanding of healthcare system in Nigeria and be able to compare team dynamics. To identify medical ethical challenges in the hospital and their implications. To explore the possibility of working as a Doctor in Nigeria in the future.
- If you had the opportunity to reorganise or redo your elective, what would you change and why?
I’m really glad that I had the opportunity to work in a state hospital and I have no regrets. If I had to redo my electives, I think I would prefer to work in a smaller hospital or private hospital as I feel I would have been more involved and the experience would have been more hands on. I felt the environment in the state hospital that I worked at was sometimes too busy and lacked organisation.
- Looking forward, how has your experience impacted your career and personal life?
A lot of communication with patents was in Yoruba. As I don’t understand the language I had trouble following some of the consultations. I realise that if I decide to work in Nigeria in the future, I may need to learn the common languages. My cousin was admitted to a private hospital whilst I was in Nigeria. Visiting her at the private hospital enabled me to see what practicing medicine is like in a private hospital, observe doctor-patient interactions and the general work ethos. I think I would prefer to work in a private hospital in Nigeria in the future.
Name: Wumi Oworu
Country of study: United Kingdom
Elective Location: University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
Elective Period: 04/04/16 to 27/05/16
Duration of Elective: 8 weeks
Speciality: Obstetrics & Gynaecology
My experience in Nigeria was a wonderful experience, although I have visited Nigeria several times before, this elective period was my first experience of living in Nigeria independently and working in a healthcare setting. Starting at the beginning, I arrived in Gwagwalada on Monday and met with my supervisor Professor Ekele, who briefly described what was to come while at AUTH. I was introduced to the head of the O&G department and the senior class representative from the University of Abuja Medical school, a young man called Etuk, who assisted me with settling in. Etuk showed me to my accommodation and was kind enough to take me to a few places to buy some food, utensils, etc. My accommodation, was a 2-bedroom flat in a block of flats containing only medical students, I had my own bathroom and I shared the kitchen and living room with my flatmate. The accommodation was a few minutes from the hospital, but still on the hospital grounds. The flat was clean and well kept, with good space and the basics. Later that day I met my flat mate Tolu, who was a lovely young woman in her penultimate year of medical school.
During my 8 week placement, I was allocated to one team for 4 weeks, where I joined them on their ward rounds, gynaecology clinics, antenatal and post-natal clinics, theatre sessions and on-call duties. Every week day morning began with a morning meeting, cases that were managed the day before were discussed and assessed. I spent 2 weeks in the labour ward, observing and assisting in the management of labour and Caesarean sections. I spent a total of 2 weeks in the gynaecological emergency unit and special care baby unit. During my elective I was taught how to perform vaginal examinations and perform a pelvic examination using a speculum. During antenatal clinics I had the opportunity to examine numerous women at various gestations. I attended to a few patients independently under the supervision of consultants in the gynaecology clinics. I performed investigations such as pap smears, endocervical swabs and high vaginal swabs. I observed cases that are uncommon in the UK, such as large uterine fibroids, primary presentation of metastatic endometrial cancer and the management of labour in a patient with sickle cell disease. I understand the Nigerian Healthcare system consists of both a private sector and national health service insurance scheme, both with their own advantages and disadvantages. The use of traditional medicine also had an impact on health, I often observed patients with advanced disease because they delayed their presentation to the hospital because they sought cheaper traditional alternatives. I had theopportunity to complete a cross-sectional study titled, ‘The Perception of pregnant women about Caesarean section at the University of Abuja Teaching Hospital, Gwagwalada’. It consisted of 131 pregnant women presenting to ante-natal clinic. I was granted ethics approval for this study. I used interviewer-assisted structured questionnaire to collect data. The acceptance rate was 70%, other literature quoted acceptance rates of 7-30%. The study showed a higher acceptance rate amongst pregnancy women who were older, married, multiparous, educated and have had a previous Caesarean section. This developed my research skills; it also exposed me to the difficulties of international research such as language barrier and limited resourced such as electricity, internet and time constraints.
I enjoyed the food to the absolute maximum, I probably ate grilled catfish at least twice a week and utilised the hospital canteen and ate pounded yam with egusi (my favourite) often. I definitely ate well while in Nigeria. The heat Gwagwalada was a different experience entirely, one I have never experienced before, I learnt to avoid being outdoors between 9am-4pm, to be well stocked up on bottled water and bought a mini-fridge as soon as I arrived (to the manifold wisdom of my mother).
When not working at the hospital, I often enjoyed myself in Abuja with my cousin and the new friends I’d made. I appreciated the order and subtleness of Abuja, in comparison to the hustle of Lagos.
I also had the opportunity to visit Kaduna, which was just a 2 hour drive away from Abuja, or an hour flight from Lagos. I also visited an orphanage a couple of times and gave some assistance.
I wish I had taken the opportunity to visit Jos, a popular city known for their cool climate, internationally known for their medical education at the University of Jos, as well as other things. Once my elective was complete, I travelled to Lagos to spend some time with friends and family.
My elective has enriched my undergraduate education, I developed basic obstetric and gynaecological skills which will be useful throughout my career. I have improved my knowledge and skills in maternal and foetal medicine. It has also given me an appreciation for the healthcare system available to patients in the UK. I have experienced another element of medicine that I will always be grateful for.
My experience has made me more passionate about pursing a medical career in Obstetrics and Gynaecology. It has also exposed me to potential opportunities in the Nigeria, especially for someone like myself – young, ambitious and open-minded.
Name: Adepero Ajayi
Hospital: Lagoon Hospital, Apapa, Nigeria
Elective Period: March 2015
Specialities: General Medicine & Surgery, Emergency Medicine/Paediatrics and Obstetrics & Gynaecology
Duration: 4 weeks
We started our rotation from Medicine > Surgery > Pediatrics/Emergency medicine > Obstetrics & Gynecology.
I would like to share about the hospital environment before I talk about the practice, if I take specific interest in discussing some issues and they seem normal to you, it is because in my school things are not particularly done that way and I appreciated that it was done with such seriousness in another practice.
The hospital environment was welcoming, everyone was practically happy to see you, always greeting regardless of who you are.
For medicine posting, we joined the ward-rounds and attended clinics, took vitals and answered a million and one questions. Many Nigerians are hypertensive and diabetic, we should watch it! I didn’t like the consultant we were assigned, so my first week wasn’t pleasant and I contemplated stopping but thanks to Ba’ami who encouraged me to continue and asked me to stop if my second posting was like that.
I resumed for the second week with fingers crossed, I’m glad I didn’t stop. They carried out at least ten procedures daily and the surgeons were excited to impact knowledge. We observed right hemicolectomy, several colonoscopy, osteotomy, hernioraphy, spinal fixture, gastroscopy, hysterectomy, endoscopy, knee replacement etc. It was sad we missed the open-heart surgeries done before we started the posting.
Everyone was very cautious of infection control, zero tolerance for any wrong act. Procedures were well explained to patients before it was done; patients were assured if they were anxious in the sweetest way ever. Everything needed for the surgery was inside the theatre, no need to run anywhere in search of what wasn’t lost in case of any emergencies.
The manner in which the patients were addressed was also something that thrilled me, such courtesy and manner of approach. At this point, anyone might want to say, “It’s because it’s a private hospital.” I beg to differ, the federal and state hospitals are meant to be better, if a private owned organization can offer that what is the excuse of the government. It is possible and that I know as two of my colleagues shared their experience in other hospitals in Africa.
The emergency room was well managed and organized, everyone alert for an emergency case. We clerked and managed patients at ER. Something that thrilled me beyond measure was the maintenance system of the hospital, which is the major reason for the dilapidating state in our hospitals. Any complaints were addressed immediately no matter how negligible it was. The cleaners were always cleaning and the toilets were always clean, ensuring toilet rolls were available.
The kitchen was another interesting part of our stay, there was no monopoly of food type and I must say kudos to the chef, my heart was at ease knowing whatever I was eating was well prepared and perfectly healthy for me. The quality of food was very good, Sike and Nonso can testify to that. The chef was also friendly; he made us food sometimes on demand.
Here I was commending the staff of Lagoon Hospital Apapa, then I attended the clinical seminar on Ethics and I was blown away with the fact that they were not relenting on the standard already created but striving for more. How beautiful! I’m used to grand rounds were patient cases are discussed but never one in which the vision, principles and values of the hospital are engraved in the heart of the staff. iCARE an acronym for Integrity, Compassionate, Attentiveness, Respect and Excellence represents the values of the organization which every member of staff must uphold at every point.
The use of electronic medical report (EMR) system was fantastic, absurd we still use case-notes, what happens if they got burnt, huh? The EMR has patients record from whenever they registered. Tests are done and results gotten as soon as possible, minimal stress on patients and doctors with the use of intercom. This makes patient care faster and more efficient.
The doctors are very friendly and they took us tutorials. Another part of the experience I enjoyed was when they ask Sike and I for our names,
“I am Ajayi.”
“What about you?”
“I am Ajayi.” Epic moment! The drama that follow is usually amusing, they give the look of ‘you guys must be joking’ we give the look of ‘we bad like that’. Lol
I was happy I met Dr Dayo, Oni, Henry, Onabanjo, Anniebuna; and Dr Bukola who saved me the day I had diarrhea, I wish you all the best.
Obstetrics and Gynecology posting was good, here we met another Ajayi. We joined during the consultations at the clinic, examined patients, observed several caesarian sections, hysterectomy etc . There is something about Ajayis and O&G.
Doctor Ajayi was so pleasant; he was my best consultant there. Dr Akinniranye was such a peace loving man, teaching with such gentleness in the intensive care unit and high dependency unit, Dr Onakoya was very interesting too, I wouldn’t forget Blount’s disease for a long time that’s if I’ll ever forget. I haven’t had my neurosurgery posting yet but Dr Ojo was willing to explain the procedure of spinal fixture to us in his usual gentle manner. Dr Jimi Coker is a man of excellence, Sike said she will rather call him Prof, so Prof Jimi Coker, this man touched my being with the way he took his job and addressed everyone under him, surgeon extraordinaire. Although we meet Dr Abudu on the last day of our rotation, explaining how he was going to do the knee replacement to us was enlightening, one of us had the opportunity to watch because of infection control, and he wanted as few people in the theatre as possible.
Two other things I noticed, the bed cover was changed for each patient in the clinic and you sanitize your hand after every contact with patients, even if all you did was give an instrument used for a patient. Hand sanitizers were all over the walkway.
I’m grateful for this opportunity as I have honed my clinical skills and have a broader view of medicine as a profession, special thanks to God for journey mercies this past few week especially when the bus we boarded collided with a trailer on the bridge. For meeting this amazing people, I’m honoured.
Have a look at Adepero Ajayi’s full post on: https://perryztot.wordpress.com/2015/02/21/my-electives-experience/