medicine

Blog

Nigerian artist makes dark skin prosthetics to boost patients’ confidence


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There is a lot of uncertainty and anxiety in society at the moment, Medics’ Inn would like to share with our community something positive.

Seun Sanni and Nneka Chile wrote a fantastic report on John Amanam, a Nigerian artist solving the problem of unrealistic prosthetic limbs for darker skin. He creates realistic and affordable limb prostheses, giving many people the opportunity to have a better quality of life. We’ve included this short interview from Youtube, but you can read more by reading the full article written by Seun Sanni and Nneka Chile at Reuters

Reporting by Seun Sanni and Nneka Chile; Writing by Hugh Bronstein; Editing by Alexis Akwagyiram and Gareth Jones.

Image: Patient, Michael Sunday, shows his new prosthetic hand at Immortal Cosmetic Art company, in Uyo, Nigeria January 7, 2020. Picture taken January 7, 2020. REUTERS/ Seun Sanni

Nigerian movie special effects expert John Amanam makes hyper-realistic, dark skin prosthetics – hoping to tackle a loss of confidence from white or unrealistic looking artificial limbs. Nneka Chile reports.
Blog

‘Pockets of memory’: Living with dementia in Nigeria


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Written by the talented Kemi Falodun, a writer and journalist based in Nigeria sharing underreported stories. We loved reading her article on living with dementia in Nigeria. It touched on multiple serious issues such as age discrimination, elder abuse and the conflict between culture and modern medicine in a way we don’t often see.

Care-givers and medical professionals in Ibadan are confronting a growing problem with love, patience and medication.

Ibadan, Nigeria – Before she started to forget things, Elizabeth Mustafa was relearning how to walk. Her diabetic foot ulcer had gotten out of control and her right leg had been amputated.

Leaning on her four-wheeled walker, she would try to manoeuvre herself around the house as someone, usually her daughter-in-law Victoria, accompanied her, watching, guiding, removing objects from her path.

Three years before she lost her leg, in 2010, Elizabeth fled religious rioting in northwestern Nigeria after receiving threats that her house and grocery store would be burned down. Seeking safety, she moved to Ibadan to live with one of her six sons and his family.

She loved telling her four grandsons stories about life in Ghana, where she was born and lived with her parents until 1969 when Ghana’s then-prime minister, Kofi Busia, passed the Aliens Compliance Order, forcing African migrants – many of them Nigerian, like Elizabeth’s parents – to leave.

Now 66, Elizabeth still enjoys telling stories about her life back in Ghana. The boys sit around her in their living room in Alarere, Ibadan, listening attentively and chipping in with anecdotes of their own as she remembers the school she attended, the friends she had.

“They [Ghanaians] are nice people. They show love,” she says in Ashante Twi, before translating it to English.

A smile spreads across Elizabeth’s face as she eases herself onto the brown sofa, holding a small radio to her belly.

“She remembers things from long ago. All others are pockets of memory,” Victoria Mustafa explains gently. 

‘Where am I?’

The Mustafas live on a neat, quiet compound. The white-walled living room is punctuated by cream curtains that drape the windows and the entrance to the passageway leading to the bedrooms. 

Victoria says this was where they were sitting a few years ago, shortly after the amputation, when Elizabeth suddenly asked: “Where am I? What am I doing here? What’s the name of this town?”

Some mornings, Elizabeth would hold a tube of toothpaste for minutes, staring at it, before finally asking what it was used for. There were times when she could not remember the names of her relatives.

“We were thinking, ‘What’s this? What’s going on?’ We didn’t understand what was happening,” says 42-year-old Victoria, who is wearing a purple shirt – the official colour of the Alzheimer’s awareness movement.

Victoria, who is from Kaduna, first met her future mother-in-law in 2004, two years before she married her son and moved to Ibadan. 

“She was active and loved to tell stories,” she recalls.

The change seemed sudden. Initially, the family assumed she was seeking ways to cope with the loss of her leg. Then they grew irritated with her. 

“We thought she was just being difficult,” Victoria says. 

It was when she started to wake in the middle of the night, struggling to reach her walker, demanding that the door be unlocked so that she could go and open her grocery store, that they realised something was wrong.

The full article was published online at Aljazeera, have a read, let’s discuss.

Image: Elizabeth Mustafa in the home she shares with her son and his family in Ibadan [Ayobami Ogungbe/Al Jazeera]

Blog, Elective Reports, Medical Elective, Tourism

Coronavirus (COVID-19)


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The coronavirus has raised concerns worldwide, “As of 9am on 8 March 2020, 23,513 people have been tested in the UK, of which 23,240 were confirmed negative and 273 were confirmed as positive. Two patients who tested positive for COVID-19 have died.” according to www.gov.uk. 2 cases have been confirmed in Nigeria, the first case was a patient who travelled from Milan Italy to Lagos Nigerian. The second patient was identified as someone who had been in contact with the first patient, both cases are clinically stable. Sources: BBC, The Guardian and Nasdaq.

What is Nigeria doing?

  • Screening at international airports
  • Public health education on how to prevent catching and spreading the virus
  • Strict isolation of those who have been in contact with virus
  • Contact tracing
  • Reporting cases
  • Hospitals are following the WHO protocol and constantly communicating with the Nigeria Centre for Disease Control (NCDC)

Due to the dynamic nature of the situation, it is difficult for us to provide you with specific advice. For those going to Nigeria (or elsewhere) for a medical placement, there are some questions you should ask yourself:

  • What happens if there is an outbreak in Nigeria (or other host country)?
  • What happens if the UK places restrictions on flights to or from Nigeria (or other host country)?
  • What happens if you become unwell with symptoms of coronavirus while at home or in Nigeria (or other host country)?

It is important to be in regular contact with your medical school before travelling to Nigeria (or other host country) so you are fully aware of any advice updates or changes in regulations. We recommend you have adequate health insurance, travel insurance (which may cover cancelled flights or have an allowance for flexibility) and a detailed plan for repatriation if it were necessary.

Although there is always more that can be done in these situations, let us remember the successful eradication of Ebola by Nigeria a few years ago.

For more information about the outbreak, travel and how to stay safe, visit:

Public Health England website: https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public, https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response and https://www.gov.uk/guidance/travel-advice-novel-coronavirus

Travel Health Pro website: https://travelhealthpro.org.uk/news/499/novel-coronavirus-covid-19-general-advice-for-travellers

The NHS website: https://www.nhs.uk/conditions/coronavirus-covid-19/

MGN Image from https://www.cbs7.com/content/news/Coronavirus-COVID-19-What-you-need-to-know-568412081.html

Elective Reports

Annie Brunskill – Medical Elective – University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria


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Name: Annie Brunskill

Country of study: United Kingdom

Elective Location: University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Elective Period: March 2019

Duration of Elective: 4 weeks

Speciality: Community Medicine, HIV medicine,  Renal Medicine, Obstetrics & Gynaecology

We had a great time at UATH on our elective and rotated through many different departments in the hospital. Local people were always very lovely to us however we got a lot of attention being two white girls on our own for a lot of the time. We met some wonderful people both at the hospital and whilst out locally in Gwagwalada and always felt safe. We were quite careful being out and about and did not wander around at night on our own in Gwagwalada. We made friends with doctors in the hospital who took us out to the Yoruba village for a beer on a few occasions.

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I can’t fault the medical experience in the hospital. We rotated through different departments to get an understanding of the different services offered. This included community medicine, HIV medicine, renal medicine and obs and gynae. Obs and gynae was a real highlight as the doctors were so friendly and allowed us to get involved clerking patients and helping with deliveries. It would have been great to work with the local medical students more – unfortunately they were on a break after sitting exams. I think it would have been more useful to the hospital if we worked in one department throughout our time as we would have got to know the unit better and would have been able to assist with activities on the ward more.

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Our elective at UATH was absolutely fantastic and I learnt so much medicine. I am hoping to visit again in the future. On the whole I think it would be a really valuable experience for international students and could be beneficial for the hospital too if we could work alongside the students more. I think that at times we found aspects of Nigeria chaotic and exhausting and did require a lot of practical support to get around and feed ourselves. I would definitely recommend a medical placement at UATH.

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Medical Elective

Staying Safe – Vaccinations & Antimalarials


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Most medical schools or hospitals have clear guidelines on the vaccinations they expect their students or employees to have received. Therefore I would advise you to look at the guidelines of the medical school/hospital/other medical environment you belong to and those of your desired elective location.

I’d advise the following vaccinations: Cholera, Diphtheria, Hepatitis A, Hepatitis B, Meningococcal Meningitis, Poliomyelitis, Rabies, Tetanus, Typhoid, Yellow Fever (Yellow Fever certificate is required at the airport and will need to be shown at passport control)

There are a variety of anti-malarials available, some more specific for Nigeria, its important you receive advice from a doctor or pharmacist before making a purchase. Make sure you are fully aware of the course for the specific antimalarial you have chosen, side effects and drug interactions if you are taking other medication.

Once you know what antimalarial you would like to buy consider buying the generic medication rather than the brand name – this will save you money! You can also calculate the exact number of tablets you need (included before and after travel needs) so you won’t have left over medication.

It may also be helpful for you to purchase some anti-emetics, anti-diarrhoeal, simple analgesia (such as paracetamol) and antihistamines. Getting diarrhoea within the first few days of arriving in Nigeria because your GI system is getting used to the pepper, leaf soups and heat is not the best welcome gift!!

Other resources (mostly relevant to the UK, so please look for the equivalent for your country):

If you have any medical or mental health conditions, seek medical advice from your local doctor before making any definitive plans or payments towards your Nigerian elective.

All medications should be purchased after a medical consultation and with a prescription. All medications should be used as prescribed by your medical practitioner.

Elective Reports

Abiola Adeogun – Medical Elective – Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria


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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 Elective4 weeks

Speciality: Cardiology, Diabetes and Endocrine, Neurology and Respiratory Medicine

 

 

  • What was a typical week like?

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.

 

Elective Reports

Wumi Oworu – Medical Elective – University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria


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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 Elective8 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.

Blog

Poem: At the Forefront


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At the forefront

They say that whatever doesn’t kill you makes you stronger

Say that to the oncology patients, the pain in their eyes, wishing not to remain any longer

My heart tremors as I walk down the corridor

The palpitations of my index fingers are too persistent to ignore

My trachea collapses every time my beeper goes off

I sweat and sweat, I try to replenish it with water, but it’s not enough

Hours on the ward seem to be long days that make me weary

I think I’ve caught what the patient was diagnosed with in bed three

Although I’m told not to, I self-diagnose

Lists of symptoms and signs I compose:

  • Fears of not being able to supply their demand
  • Suffocating my thoughts with predictions and plans
  • My imagination runs wild as I begin to contemplate
  • Mistakes and devastating actions I could make
  • That leaves someone who trusted me in pain
  • Scribbling my signature at the bottom of their records – shame
  • Blood stained resume no longer fit for practise

(A disgrace to the Medical Council, incompetent and useless)

  • These notions come to greet me every moment of the day
  • They’re absent at breakfast, present at lunch, occasionally there at dinner, they never go away
  • Making me question my ability and sanity in this field
  • I’m no longer in control of how I feel

But since I’ve started sharing the content of my mind

Something has been fertilised inside

Teamwork introduced me to ‘Mechanism to cope’

These thoughts of the day seem to be replaced with hope

Lately I’ve befriended a new angle of view

It is a subtle friendship because those that know about it are few

The budding beginnings bring about brand new brainwaves

Constantly contemplating and constructing confident considerations which are crucial

I think I’ve come to understand that I’m not the superhero the world has been waiting for

This fight isn’t over; battles are being won every day but we all remain in war

Nevertheless it is the daily combat that keeps things ticking

The persistent resistance against invasion

The inconsistent resilience that makes us human

And the hope of tomorrow that keeps us going

 

 

 

This poem is titled ‘At the forefront’ because it expresses the thoughts of a doctor who is struggling with the harsh uncontrolled reality of death and disease. They are constantly faced with patients who look to them for help to overcome their terrible disease they battle. At first it is all too much for Doctor A, the mental and emotional problems are presenting themselves physically, or so he believes. This portrays the first big idea in Whole Person Care, ‘Illness and its remedies lie at many levels within a system’; although the pathology can be explained through the activity of adrenaline in the body there is an emotional level that suggests a the trigger for the release of adrenaline, it is more likely that clinical signs have emotional factors are their trigger. This also addresses idea seven, “We can learn from different philosophies of health.”; the psychobiological relationship presented by Doctor Amid shows that his mental health affected his physical health, hence the physical manifestations of his worries. Integrative Medicine is employed by many practitioners to focus on the patient as a whole and to make use of all appropriate therapeutic approaches; if Dr Amid presented his physical symptoms to a fellow doctor it would be easy for his colleague to be absent-minded towards Dr Amid’s emotional symptoms and only treat the physical issue.

He comes to a point where he is emotional attached to the patients he cares for. In order for a practitioner to relate to their patient they must be able to empathise, it should be something that is constantly applied throughout a consultation. Although, being human means a doctor is often subject to emotion, empathy can consume a doctor, leaving them in a dysfunctional state. “…I think I’ve caught what the patient was diagnosed with in bed three. Although I’m told not to, I self-diagnose. Lists of symptoms and signs I compose…”. But this is something that we can all identify with, when we’re too attached to a vulnerable person we become we bear their burdens as if we were them. Empathy should be a costume doctors wear when needed, but in order to make rational decisions this costume must be taken off, it is then put on again when appropriate.

‘…Effective relationships are central to effective care…’ is the fourth Big idea, kit wasn’t until Dr Amid shared his fears and used the support system around him that he was able be released from his prison of negative thoughts. It was through teamwork that he was able to know about these mechanisms.“…But since I’ve started sharing the content of my mind. Something has been fertilised inside. Teamwork introduced me to MOC ‘Mechanism to cope’. These thoughts of the day seems to be replaced with hope. Lately I’ve befriended a new angle of view…”. The effective relationship between Dr Amid and his colleagues lead him to effective care.

The poem ends with Dr Amids new thinking; it is evident that the new technique adopted by him has created resilience. This ending does not paint a safe, comfortable and nice image of life as a doctor but accepts the reality that death is painful and despite human intervention, is inevitable. “…The inconsistent resilience that makes us human…” this shows that Dr Amid is still on a journey, like many us this journey may last for a lifetime. In practise resilience can be hard to define because people are different therefore their resilience will manifest differently; there can be no time allocation, characteristics criteria, physical duties or a check list to be ticked off. Resilience in intrinsic, it is a characteristic that can only be activated by yourself, which confirms the sixth Big Idea ‘…Self-care helps create resilient practitioners..’.

Dr Amid is a fictional character that represents the thoughts and worries of medical students and doctors.

 

Photo Credit: PhotoPin

Blog

Medical School Can Be Tuff


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Medicine is similar to other professions is many ways, but it is also different from other professions in many more ways. The hustle of medical school is like no other undergraduate course. As well as studying for a degree, you have begun your training for the career. Your career starts now.

You have now adopted a culture where juggling numerous extracurricular activities is the norm; you turn down more social events than you’d like; your term/semester begins with, is interrupted by or end with 1-3 assessments or exams! The list goes on. Only other medical students/student doctors understand this way of life. Although your family and friends are very proud of you, there is an air of disappointment. Even though you try to explain the structure of your course, the emotional demands, the time constraints, your goals and aspiration, “they just don’t get it”.

But remember you are not alone on this journey, there are hundreds of students just like you in the country, and there are thousands of students around the world in your position (some worse off). Stay true to your convictions and try to maintain a healthy balance of things. Know your priorities. Remember, medical school is but for a season; how you handle medical school is an indicator of how you will handle life as a doctor.

Medics’ Inn

Blog

Medical School:Have A Kit Kat…Take A Break!


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In medical school, you adopt the ‘work hard’ culture, but it is equally important to remember the culture of relaxation. Sometimes, the moment you sit still, you feel a sense of guilt for not doing ‘something’. The truth is, in Medical School, there will always be ‘something’ for you to do. There is always work to do; this could be revision for an up-coming exam, research for a written assignment, follow-up work in the lab, staying after working-hours to practise a particular clinical skill, spending some time in theatre, preparing for your next tutorial/lecture/lab project – these demands do not include the extra-curricular activities you have picked up along the way or paid work. Sports, dance classes, creative workshops or conferences that require the submission of a paper/abstract/poster, etc. The list is endless. The list will continue to be endless. So it is import to relax and truly switch off. Put to one side the daily, weekly and monthly demands of medicine for a moment and just relax.

Have a break. Enjoy the break.

 

Photo Credit: Photo Pin

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