Should have followed up on the letter.........Damn!

Henry was working late into the night again. He had a pile of paperwork to go through. No matter how hard he worked during the day, there was still so much to take home.
Damn, sleep was gradually taking over. His eyelids had started giving up when a skype call came in on his computer. It was Candy! He hadn't spoken to her in years.
"Hello Candy, how are you? It's been ages you know".
"Oh yeah, just thought I will give you a call. Just changed jobs and I so wanted to tell you about it".
"Wow, congratulations. So where is this new job?"
"Oh, it's with the US Embassy. I handle Diplomatic Relations".
"Hmmm, you are mixing it up with the elite crew now. Good for you".

And that's how they went on for the next three hours. It reminded Henry of their high school days when long phone chats were a regular ritual for the two of them. They were so close then - some sort of celebrity couple, that tongues always wagged all over school. He missed those days, when he could tell her everything (his goals, achievements, successes, failures, about his relationships etc)

Funny that it was Dele, one of his pals who introduced Candy to him. Dele who was now living somewhere in Antigua called him a few months ago and while they were talking had brought up nostalgic memories too. Dele had confessed to being envious of the Henry-Candy friendship.
"I introduced you two to each other, and yet you became so close that I even began to doubt it was me who started it all. It seemed at the time, that you had been inseparable from birth"
Initially, there were the three musketeers (Henry, Candy and Dele) but gradually they drifted off without Dele. They had secrets he knew nothing about, there were several phone conversations that happened without him and quietly, he slipped off to find new friends.

Henry and Candy read together for their exams, and were popular for their academic exploits too; he always won the English prize while she had her firm hold on the Physics one. Their long walks from the laboratory to the school cafe was always full of laughs, giggly pokes and the occasional pecks.
Even when they went back to school, they wrote each other every fortnight. Henry's school mates could always tell by his bright toothy smile that another letter had come in from Candy, and he was never ready to help with any tasks that took place when he was drafting up letters to her.
But that was years ago, things were different now. He heard from a former work colleague that she was engaged to some oil company bloke, and talks of getting married were in the air. As he answered her questions over skype, he could hear his wife's shrill voice from the bedroom as she talked to his mother-in-law. The conversation was regularly interrupted by his ten month old son's chatter.

It was fun talking to her again, and suddenly it was like they had gone back in time. They talked about everything again.

Maybe he should ask her now.......
"So Candy, why didn't you reply the letter I wrote halfway through SS3?"
He had been a bit worried before posting the letter. After days of drafting, re-drafting and re-editting the letter, he still left the words largely inscribed at the top of the note.
It was the first time, he was writing about how he really felt about her. He talked about how she was his best friend, and how he had palpitations when she laughed, how she had a way of solving all his problems and how he couldn't sleep for days when she gave him a peck.
After pouring out his heart, he wrote the words "I LOVE YOU" at the top in the best cursive writing he could muster. Smiling unashamedly all the way to the school post office, he couldn't help imagining what she would write in her reply letter.
Unfortunately, he never got one! Maybe, she wanted them to remain as friends. He was so hurt that he never wrote back.
They met again a couple of months afterwards in the University, but he did not have the courage to ask her. He was devoted to his law books and she was an Engineering student with fingers in student politics. They now had different sets of friends and their paths never seemed to cross.
There was the occasional wave or phone call, but nothing like before. They drifted further apart post-graduation, and that was about five years ago.
------------------------------------------------------------------------
"What letter are you talking about, Henry?"
"The last one I wrote to you in school".
"Which one? I really can't remember now. Was there something I was supposed to reply about"
He was gobsmacked. Didn't she understand what the letter meant to him?
"I wrote about how much I loved you and how much I wanted us to be together"
"Oh noooo, Henry, I never got that letter. I waited for years for you to tell me something like that. Did you really write that? I wondered why you suddenly changed a few months to Uni"
He sat staring at his wall in shock.........................

Nollywood: Influence on Nigeria’s Health Care System

There was an intriguing debate a few weeks ago on the Facebook forum for Nigerian doctors all over the world – “Naija Medics Worldwide”. A flurry of posts was triggered off by an article posted by Dr Peter Adeosun, a resident doctor at the Obafemi Awolowo University Teaching Hospital, many complaining of the ill-effects of Nollywood movies on the health care attitudes of Nigerians.
Just like Hollywood and Bollywood, Nollywood has become the name for Nigeria’s feature film industry. Many might not believe this, but in terms of annual film productions, Nollywood is the second largest film industry in the world (second only to Bollywood). The great Hollywood comes third on the rankings. Most Nollywood films are really soap operas – they try to portray the typical Nigerian family or society, and have become increasing popular since 1992 when the film “Living in Bondage” was released. Not just Nigerians watch Nollywood movies, it has gradually crept into the homes of millions all over the world. I was shocked when a Jamaican friend told me her favourite film was “Osuofia in London”!
To the simple mind, movies just educate and entertain; but a more critical review would show that movies reinforce tendencies, help to sell a brand and allows us to see stereotypical perceptions as the norm. Dale’s Cone of Experience – a tool often cited by learning experts shows that we tend to remember about 30% of what we see. Whether this figure is accurate is another issue, but most people will agree that what we watch has a great influence on what we do or how we come to perceive things. Nollywood and Nigerians are no different; people have come to transplant what they see in Nollywood movies into their everyday lives.
As a doctor, I usually watch programmes like ‘House’, ‘Casualty’, ‘E.R’, ‘Grey’s Anatomy’, ‘Scrubs’, ‘Holby City’ and ‘Monroe’, and I am impressed at the attention to detail when acting out medical scenarios. There was a colleague of mine who prepared for his postgraduate medical examinations by watching “House” when he was taking time off his books. Every episode had a new clinical presentation and an interesting diagnosis. Some of the filming for “Monroe” (another series based in the hospital setting) was done in a hospital I had worked in and some of the medical staff were invited to join the film crew to ensure that it was as ‘real-life’ as possible. After watching it, I had to agree that they were “spot-on”.
Why doesn’t Nollywood do the same? What Nollywood does is reinforce the set of harmful customary beliefs and practices that contradict safe modern-day health principles in Nigeria. To make things worse, with the lack of access to sources of quality information for many Nigerians, the best health education teachings many get will be from their stack of Nollywood CDs. Imagine the impact if Nigeria’s film industry could team up with the Nigerian Medical Association (NMA) or the Ministry of Health. Safe health care practices will be seen and learnt, medical professionals will be seen as people that can be trusted and believed & disease conditions will be dealt with more urgently. There was a series called “Doctors’ Quarters” on MNET some years ago featuring Kate Nuttall-Henshaw which tried to address these issues but unfortunately did not last too long on TV. By the way, ‘Doctors Quarters’ was not really a Nollywood programme and was only shown on DSTV so not everyone got to watch it.
Just so that you have a grasp of how big the problem is, here are a few excerpts from some Nollywood movies:
- A man reading a newspaper suddenly falls down and starts shaking vigorously with some foamy liquid coming out of his mouth. The wife and daughter start shouting that he has a heart attack.
- Dressed in a scruffy manner (he looks like he has just been across the Sahara desert) but with a stethoscope around his neck, he blurts out “Hello everybody! Your mother is in a critical condition in our ICU now and she has just 2 days more to live. If you don’t get the money for the operation by tomorrow morning, she will die”
- “My sister, you have contracted staphylococcus disease? If you don’t use these antibiotics, it can transform to a very chronic virus’.
- A doctor places the outside part of his hand on the patient’s forehead and says “ Aaaaah, this patient has been poisoned and it is beyond medical treatment”
- Two cars collide and passers-by quickly gather to start dragging people out of the vehicles. (No one remembers to keep their necks immobile because of the risk of spinal cord injury)
I cannot remember a lot of Nollywood doctors giving good news. All they say is “We have tried our best but the patient died” or “This one is beyond us, it requires spiritual treatment”. No wonder, so many people believe in metaphysical aetiologies for the simplest medical problems. The hospital scenes resemble a room on a poultry farm (no wonder no one wants to go to hospital!). A typical cubicle contains a make-shift bed covered with a white bed sheet, and the patient has an empty drip bag swinging over him/her. The drip cannula on the patient’s arm could be in any cardinal direction (north, south, east or west). The doctors shown in Nollywood movies are very limited in their diagnostic abilities. They can diagnose pregnancy (very well….), malaria, typhoid and AIDS, but nothing else. Any other diagnosis leaves them extremely confused and so the patient’s family end up going to the pastor, imam and most times, herbalist. The herbalists are the ‘know-it-alls’ and they never get it wrong (…or at least that is what the family and the film watchers are made to believe). Some of them, as part of their treatment protocol even advise that the patient should not get any second opinion or else the condition will get worse.
Now, I don’t hate Nollywood! I strongly believe it is one of Nigeria’s most successful exports and I would not say all hope is lost. Simple medical maneouvres can be taught via the films e.g. CPR (cardiopulmonary resuscitation), Heimlich’s maneouvre, haemostasis (controlling bleeding) using pressure etc. The values of childhood immunization, good nutrition, compliance with medications and prompt presentation to hospital should be emphasised on. Medical experts should be invited to advise on scenes that show “anything medical” instead of us being fed the fruits of a film director’s imagination. Nollywood movies can be an excellent means of public health education and it might even achieve much more than health education experts! Hope the guys at 51 Iweka Road, Onitsha and Idumota market, Lagos are reading this?

CAN WE REPAIR THE DISCONNECTION?

Scenario 1

I was a 300level medical student and hadn’t been home in ages. As I walked down my street, I met the security guard. Immediately, I could tell there was something wrong.
“Doctor, I have something to tell you” He gestured that I should come off the street and talk to him under the big mango tree.
“My friend had sex with this girl, and after a few rounds, she started having a seizure”
He paused for a few seconds.
“Doesn’t that mean he has contacted something and would also start having seizures too?”
I shouldn’t have, but I laughed.
“Oga Kadiri, it wasn’t your friend, it was you”
“Ok, ok, oga dokita, it was me! I am in trouble, abi?”
I took about thirty minutes to explain as much as I could about seizures and why it is not sexually transmitted.

Scenario 2

We spent about twenty minutes trying to resuscitate the baby, but all our efforts were futile. The baby was brought in by the mum and we had diagnosed neonatal tetanus.
The mum wailed and shouted after we broke the sad news to her.
I asked her afterwards, why she had not ensured her baby got the necessary vaccinations.
“K’osele ri ni ile wa” (English translation – It has never happened in our house). I remained sympathetic but shook my head thinking that 100 quid & good health education would have prevented what just happened.

Scenario 3

I had not called him in ages, so it was fun to chat with him again. He was about 25 years older than me and I always asked him for advice. He had lived in the UK in the 80s and always asked me about the cities he had been too. Now he was no ‘continental rookie’, he had been to nearly all world’s continents.
When I asked about his health, he told me had been recently diagnosed with hypertension and diabetes.
“Oooh, so what medications are you taking then?”
“Folusho, I don’t really take them but I always take my YoYo bitters”
I felt like slamming the phone. C’mon, he is an educated man!

Now the three scenarios described happened in the 21st century and there are so many other examples of where the people would believe their herbalists, alternative health practitioners, pastors, imams etc more than the doctors. Why do we allow traditional myths to overrule common sense? Patients will remain in their house until the chances of obtaining any recovery is pretty much 0%.
We are not a dull nation but I think there is a fundamental disconnect between the medics of my country and the Naija populace. It can’t just be that we are a boring species with no appeal.
Or maybe the health education is inadequate. I say this because I was once involved in talking to some members of a rural community somewhere in 2002 about hypertension. After explaining as much as I could in the best Yoruba I could muster using as many analogies as possible, they all asked to have their blood pressures checked. Most of them had never had it checked and did not even have any idea what ‘blood pressure’ was all about. They wanted to know what they could do about it if they were diagnosed to be hypertensive.
Is there any way we could improve the interaction with our populace? Is there any way we could improve our appeal?

Tribute to GrandPa

As a child, the earliest memory of grandpa was when I was about 7. "Baba Igbajo" as we all called him, was so much fun to be with. He would tickle you till you could laugh no more. I still use the same tickling tricks when I play with Dee. I remember thinking why he was called "Baba Igbajo". Was he the most popular person in the town? Or was he the oldest? The things kids think about :)

I would never forget the first day he tasted ice cream. We had scooped out a good amount for grandpa to enjoy some of our own pleasures. No one could have predicted his funny response. "Wo bo se ri bi omi omu iya mi" (roughly translated - Wow, it tastes like my mother's breast milk!). He left me in stitches that day - I couldn't help wondering what age my lovely grandpa got weaned off breast milk. No wonder he was so strong and agile. A good example of the wonders of that lactating fluid. You would have made a good advert for the Ministry of Health!

He regaled us of stories of adventure, risks and life in Igbajo's rural setting. We were amazed at how he got his finger amputated when he fell off a tree. We looked forward to the yams and bush meat that he always brought along with him. The stew tasted different for weeks afterwards and there was more yam to pound every Sunday (and Monday, Tuesday, Wednesday etc). Thank you Baba, for the numerous yams presented to my wife's family during my wedding engagement. I was proud of your exquisite farming skills when I saw the colossal tubers.

As I grew older, I appreciated the closeness exhibited by my mum and her dad and as I type these words, tears are welling up in my eyes because no one else will feel your departure as much as she would. It made me value the parent-child bond between you two, that remained evergreen despite the many years apart. Mummy's eyes would always light up whenever she spoke with you or when you came visiting.

My friends envied me whenever I said all my grandparents were still with us. We saw you live past the 70, 80 and 90 year landmark and appreciated the gift of strong genes. We always saw our strong "Baba Igbajo" who remained a hardworking farmer even in his old age. This made me it rather unbelievable when I spoke to you over the phone and heard the stroke-induced slurring of speech. It couldn't be! Even then, you showed how much of a fighter you were. many would have waved the white flag of surrender but you recovered and showed anything is beatable.

I feel pained because I wanted you to see me get to the very top and make you proud of my achievements. I wanted you to see your grandson exhibit the same skills of strength, risks, adventure and hard work you displayed throughout your life. I wanted to make you proud of me.
I won't wave the white flag, you might not be physically around but you would see me from above and keep me right. This is so painful.................

Till we meet again, Baba Igbajo! I would miss you so much!!!

Getting rid of the Goliaths!

“Some things are just meant to be” Kim tried encouraging herself.
She looked up from the bed as the sun rays streamed through the window panes.
Kim’s dream was to become a politician at the highest level. For the last ten years, she had read several books and biographies on political matters. She understood the class struggles that provoked Che Guevara, respected Nelson Mandela’s quest for reconciliation and appreciated the leanings of the American Founding Fathers. She had attended several conventions, spoken at several meetings and met with hundreds of interest groups.

“Should I submit the registration form? Can I win the elections?” This was what she had waited for, and yet thousands of doubts crept in.

----------------------------------------------------------------------------“Quitters don’t win and winners don’t quit”

I have had several favourite quotes but this one falls into my top three. As a teenager, I had those words pasted on my bedroom wall and they went a long way to keeping my feet on the ground. I am sure there is some God-given ability in great men/women that defies setbacks and failures.

Michael Jordan is still regarded by many as the greatest basketballer, but very few will believe that he was not picked in his sophomore year because he was too short. During the Atlanta 1996 Olympics, I could not believe my eyes when I saw Michael Johnson pose by the timer with 19.32 seconds glaring boldly on the screen. Many years before, he had been told by coaches that his peculiar running style (short steps and stiff upright stance) was not the stuff of champions.

As a child, Richard Branson was regarded as dyslexic but today he owns Necker island and his Virgin brand is famous worldwide. Ben Carson rose from the pressures associated with a broken family and racial stereotyping to become a renowned brain surgeon and recipient of the Presidential Medal of Freedom. Just in case you are wondering, the award is the highest civilian award in the United States.

Winston Churchill did very poorly in school and even had to do the entrance examination into the Royal Military College, Sandhurst thrice but went on to become Britain’s greatest prime minister and the only one to win a Nobel Prize in Literature. I don’t even need to tell you about Abraham Lincoln – his story of pre-presidency failures are very well known to all!

The truth is, you can achieve anything you want to achieve!!!

A Mischievous Phone Call!

It could be a sinking feeling sometimes when the bleep goes off. As the doctor on call in a large department or hospital, when all you have been doing all day is trying to save lives and you can't remember the last meal you had; what you don't want is "that phone call"!
The phone call could either leave you bewildered, or create tasks that will take up your next four hours. Sometimes, it could be a referrer with an attitude that stinks.
The feeling is even worse if its your first day in a department where you have no idea of how to manage their difficult cases.

Anyway, a couple of years ago, I went on a night-out with some work colleagues of mine. We went to 'some really cool' restaurant in the Leeds town centre and ate, drank and chatted till very late. I really can't remember whose idea it was, but we decided to play a prank on the junior doctor who was on call on the department. It was her first day on night call in the Neurosurgery department so we all felt the prank would have maximal effect too!
I felt I would be the best at causing the mischief so I whipped out my phone and dialled the number for the hospital switchboard. Within seconds, the switchboard operator had picked up and I asked to be put through to the Neurosurgery SHO on call.

Everybody went quiet. "What was Andy going to say?"

'Hello, is that the Neurosurgery SHO on call'

'Yeeesss' Quivering voice on the other end.

'Ooooh, fantastic, I have been trying to get in touch with your registrar but I think he is busy in theatre so I had no choice but to call you'.

'Okaaaay!'

'My name is Martin, and I am one of the A&E registrars. Can I make a referral?'

'Yeah, go on'

'We have got a young gentleman, say about 23 who was brought in by his friends. I think they had been drinking out all night. He has come in with a bucket stuck onto his head and has become unresponsive. The bucket is stuck on so we can't really assess his GCS, but he is making incomprehensible sounds'and has got some limb weakness.

'Eeeerrrrrrm' She sounded scared now, but I went on.

We need an urgent CT scan on the man and have got him down to the CT department, unfortunately we still cannot get the bucket off, so we will need someone from Neurosurgery to take care of that'

'Ooooh my gosh, erm erm erm, I will need to try my registrar again or or or.......'

Everyone on the table in the restaurant burst into laughter. I had kept a straight face throughout and had done well not to laugh at all, but at that point, I guess I couldn't torture her anymore as well.

'Kate, its Andrew. I have got the whole crew here, we just wanted to scare you a little bit'

' Aaaaaaaah Andy, you scared me, I'm gonna kill you! Are they all laughing at me?'

'No, not really? Let me leave you now, I'm so sorry I disturbed your call.

I hung up and we kept laughing again for a while.

The next day when I got to work, I went looking for Katie and apologised immediately for my mischievous act.
Strong girl, she didn't even seem to mind!

They've been there for ages!

With all the recent uprisings in North Africa, I could not resist the temptation to do some research on Africa’s longest ruling leaders. Is there something about the continent, regarded as the cradle of humanity, that makes the leaders cling on to power for so long? Would it require a supernatural act to get the countries to amend their constitutions allowing, say a five year term?

Anyway, here are Africa’s top ten current longest ruling leaders. You would notice I have included the men who have been making the headlines in the last few weeks (i.e. Ben Ali, Mubarak and Gaddafi)

10. PRESIDENT ZINE AL-ABIDINE BEN ALI of TUNISIA (7 November 1987 to 14 January 2011)
President Zine al-Abidine Ben Ali came to power following 84 year old Habib Bourguiba’s impeachment on medical grounds in line with Article 57 of the country’s constitution. Riots over unemployment, which started in December 2010 gradually increased in intensity and Mr Ben Ali had to flee to Saudi Arabia in January 2011. A caretaker committee has been set up prior to the next elections.

9. PRESIDENT BLAISE COMPAORE of BURKINA FASO (15 October 1987 to date)
In a country called “Land of Upright Men”, Blaise Compaore, 33 years old at the time became the president after Thomas Sankara’s mysterious death. He was elected president in 1991. The opposition boycotted the elections making it a very easy process. President Compaore has since won three elections in 1998, 2005 and 2010.

8. KING MSWATI III of SWAZILAND (25 April 1986 to date)
King Mswati was crowned in April 1986 as a 18-year old. He had been chosen to be king at the age of 14 in 1982; but since he was still too young, two of his father’s wives served as regents while he continued his education in England. As an absolute monarch, he has the power to elect the Prime Minister, members of the cabinet and the judiciary.

7. PRESIDENT YOWERI MUSEVENI of UGANDA (26 January 1986 to date)
Yoweri Museveni toppled Basilio Okello in January 1986 to become Uganda’s president after several talks and peace treaties had broken down. In 2001 when Museveni won the presidential elections by a substantial majority, there was only one challenger - his former friend and personal physician Kizza Besigye.

6. PRESIDENT PAUL BIYA of CAMEROON (6 November 1982 to date)
Prior to becoming president in 1982, Mr Biya had been Prime Minister since 1975. After being re-elected in 2004, Biya was barred by a two-term limit in the Constitution from running for President again in 2011. In his 2008 New Year's message, Biya expressed support for revising the Constitution, saying that it was undemocratic to limit the people's choice. Four months later, the constitution was amended with the time limits removed.

5. PRESIDENT HOSNI MUBARAK of EGYPT (14 October 1981 – 11 February 2011)
Vice President Hosni Mubarak took over after President Sadat’s assassination (President Sadat had set up a peace treaty with Israel) by Islamist militants in October 1981. He was confirmed as president by a referendum. Mubarak survived several assassination attempts and has been re-elected in a referendum for successive terms on several occasions. Following the recent uprisings in Egypt, he had to give up office.

4. PRESIDENT ROBERT MUGABE of ZIMBABWE (18 April 1980 to date)
Robert Mugabe led his ZANU party to victory at the elections in February 1980, after Zimbabwe had won its independence from Britain. He served as Prime Minister from 1980 to 1987, and has been executive head of state since 1987. Currently he is sharing power, with Morgan Tsvangirai as Prime Minister - but remains president.

3. PRESIDENT JOSE EDUARDO DOS SANTOS of ANGOLA (10 September 1979 to date)
President Jose Eduardo dos Santos assumed power following the death of Angola's first president, Agostinho Neto, in September 1979. He is also the leader of the MPLA (People’s Movement for the Liberation of Angola), the party that supports the Angolan government. He is widely believed to have survived an assassination attempt in October 2010.

2. PRESIDENT TEODORO OBIANG NGUEMA OF EQUATORIAL GUINEA (3 August 1979 to date)
President Nguema is the current Chairperson of the African Union. He came to power in August 1979 after deposing Macias Nguema. After an amendment of the constitution in 1982, Nguema was elected to a seven year term. Interestingly, he was re-elected again in 1989 as the only candidate. President Nguema is an expert at elections, as he won 97% of the vote at the elections in 2002. He had another landslide victory in the recent 2009 elections.

1. PRESIDENT MUAMMAR GADDAFI of LIBYA (1 September 1969 – probably very soon)
At the moment, Africa's undisputed longest-serving ruler is Muammar Gaddafi, who has been in office since 1969. That means all my life; I have not known Libya to have any other leader. Col Gaddafi at the age of 27 with a group of a few junior officers led a bloodless coup to take over from King Idris who had travelled out of the country for medical treatment.
He is generally considered as being controversial – the Amnesty International hold him responsible for several assassinations. His bodyguard contingent known as the Amazonian Guard is made up entirely of females, who are virgins, well skilled in martial arts and handpicked by Gaddafi himself. He is currently facing an uphill battle, as widely publicised by the media to hold on to power.