What kind of doctor are you?

“What kind of doctor are you?” asked Grandma. I was seized with fear. “Why?” Grandma was just recovering from a crippling stroke. Initially, her speech was slur and incoherent but improving every day and in the last two weeks had become more fluent. Now she has developed a twisted sense of humour and making expensive jokes. I was worried that my visitors might take whatever she said as Gospel truth.  

    

A story a friend of mine had told me about an elderly lady who was asked a simple question as a witness in a court of law, re-echoed in my ears. The prosecutor had called the grandma to the stand as his first witness. He approached her and asked, "Mrs. James, do you know me?” She responded, > "Why, yes, I do know you, Mr. Williams. I've known you since you were a young boy, and frankly, you've been a big disappointment to me. You lie, you cheat on your wife, and you manipulate people and talk about them behind their backs. You think you're a big shot when you haven't the brains to realize you never will amount to anything more than a two-bit paper pusher. Yes, I know you."

The lawyer was stunned! Not knowing what else to do, he pointed across the room and asked, "Mrs. James, do you know the defence lawyer?" She again replied, "Why, yes, I do. I've known Mr. Johnson since he was a youngster, too. He's lazy, bigoted, and he has a drinking problem. He can't build a normal relationship with anyone and his law practice is one of the worst in the entire state. Not to mention he cheated on his wife with three different women. One of them was your wife. Yes, I know him." The defence attorney almost died. The judge asked both lawyers to approach the bench and, in a very quiet voice, said, "If either of you idiots ask her if she knows me, I'll send you to the electric chair.”

It has been difficult to forget this story so I braced up for the worst. Grandma repeated the question, “What kind of doctor are you?” I quickly answered, “I am a medical doctor.” “No you are not!” retorted grandma. I was alarmed! Grandma had always known me as a doctor. What exactly does she mean? I was worried. “I have searched through the Internet and to my amazement I could not understand why you call yourself a doctor. I stumbled on your university certificate and it read, Bachelor of Medicine and Bachelor of Surgery.” For all practical purposes, you are a Bachelor of Medicine not a Doctor. I heaved a sigh of relief.  “Thank God we are not going along the line of the other grandma and the lawyers. If that’s all, I can easily deal with it.

“Grandma, you are right. The appellation of Doctor (Dr.) is just a title describing the vocation of those in the profession of medicine. It is not a university degree. We can say it is descriptive just as you associate a bricklayer with bricklaying and a barber with taking care of the hair. The title is endorsed by the Medical and Dental Council of Nigeria which is the regulating body. It is not a university degree.

Grandma seemed pleased with my response but as I was about to take my leave, she asked again, “Ben, I am a bit confused. What about the Doctor of Veterinary Medicine and Doctor of Optometry?” “These two are notable exceptions - aberrations. They are both first degrees awarded by the university. They are neither medical doctors nor Doctor of Philosophy. Doctor of Philosophy (PhD) is awarded by the universities as a postgraduate degree,” I explained carefully to grandma.

“Ben you are yet to answer my question. What kind of doctor are you?” Grandma asked again. “I am a medical doctor who later specialised in medical and surgical treatment of the eye,” I replied. “Doctor Ben do you mean you’re an Ophthalmologist?” “Exactly, you got it right! After a 6year study in the university and graduating as a medical doctor with Bachelor of Medicine and Bachelor of Surgery degrees, I spent another 6years studying ophthalmology to become a specialist eye doctor,” I explained.

“I can see you are in a hurry to leave. I have just one more question for you.  What exactly is the difference between an Ophthalmologist and an Optometrist – both prescribe glasses and both are called doctors?” “Grandma, an ophthalmologist is a medical doctor who has undergone additional training to become an eye specialist and takes care of both medical and surgical treatment of the eye. A doctor of optometry (an optometrist) is a first degree university graduate who is trained to assist in eye care with special emphasis on prescription of glasses and optical aids. He is not a medical doctor; should not give any treatment beyond first aid and primary care; cannot issue sick certificate or write medical report on the state of health of a patient.” My phone rang and I quickly seized the opportunity to scram. 

What kind of people are you Nigerians?

In 1985, a colleague of mine from an East African country, who had shared an apartment with me when I was in USA, visited Nigeria for the first time. Looking pensive, he asked, “What kind of people are you?” I drew blank. So he repeated the question, “What kind of people are you Nigerians?” 

As I was trying to figure out where he was going, he volunteered the answer. “Ben, I can’t understand you Nigerians. When we were in Baltimore, you were always complaining about your country. You complained about everything and everyone. I arrived at the airport in Lagos a few days ago, it wasn’t particularly impressive but I made one remarkable observation.” “What’s it Dave?” I asked, now all ears and anxious to hear what he had to say. “From the moment my plane taxied to a stop to the time I arrived at my hotel, I did not see any foreigner directing the affairs, pushing Nigerians here and there. Then I arrived here at the University College Hospital, Ibadan (UCH), the administrators, doctors, nurses, laboratory scientists and all those directing the affairs of this huge and beautiful edifice are all Nigerians. For the first time in my life, I am in an African country where Africans are in charge of their affairs.” He said almost breathless and added, “Come to my country, we are the cleaners, messengers, stewards and housekeepers. The airport bosses, hotel managers, doctors, nurses and those directing the affairs are all foreigners. You may not be doing it right now but you have started and one day you will do it right.” Tears welled up in his eyes as he lamented, “In my country we are yet to begin.”

He had stirred up my memory. I remembered vividly that whenever we Nigerians in US met, all we did was to tell stories about how rotten our country was – the corrupt leaders; bribe taking policemen and custom officers, NEPA, the poor state of our roads, etc. We criticised everything and everybody as Dave had said. I was still ruminating over this, when Dave asked again, “Ben, what is the driving distance from Lagos to Ibadan?” “It’s about 120km,” I answered, wondering what he was going to say next. “That distance would take just a little over one hour on an express road in USA. It took us over 4hours owing to severe traffic congestion. Your government needs to do something urgently about it. I would suggest the provision of parallel service roads at all exit and entry points along the road. In addition it is imperative that alternative means of transportation such as a fast train service be provided.” I couldn’t but agree with him.    

It is distressing that 30 years after Dave’s visit and suggested remedies, the gridlock has continued and even worse! Travel time is about 3hours occasionally but most times uncertain and could between 4 to 6 hours! The road is now being rebuilt with more lanes but without the parallel service roads at entry and exit points. And more importantly, no alternative to road transportation has been provided. Goods, passengers and all have to take to this road which is perhaps the busiest in Africa and one of the busiest in the world. It is clearly obvious that just rebuilding the road as is being done is not a solution to the perennial gridlock.

Now it is my turn to ask, “What kind of people are we? Why should we have a problem for over 40years and cannot think of innovative ways of solving it? Why do we continue to use yesterday’s solutions to solve today’s problem?  

These questions are equally pertinent to health care in Nigeria today. Nigerian is blessed with skilled experts in all fields of endeavour yet we continue to wallow in abject poverty of mind and body. If we are doing exactly the same thing, in exactly the same way as we did yesterday we are certainly not doing well. We must begin to think outside the box and train appropriate health care workers who will meet the challenges of today. If need be, we must break down professional barriers and rebuild the entire health sector. Faced with dwindling resources, we cannot afford the luxury of the compartmentalisation of healthcare professions of the developed countries and must adapt new technology to find solutions to the challenges we are facing.

Finally, I ask, “What kind of person are you? Have you had a comprehensive eye examination in the last one year? We are still seeing patients who are nearly blind from glaucoma who felt all was well with their eyes. If you are seeing very well and you haven’t had an eye examination in over a year, you could be one of them. Please visit an ophthalmologist today for a comprehensive eye examination. Keep what you have. The eye is not yet replaceable!     

“If I can’t have a hospital that can nurse me to health, give me one I can die in.”

From my bed I peeped through the window at the road below. For the first time since I was wheeled into the private room of what is called a hospital three days ago, I became conscious of my environment. I had been in great pain; body ravaged by high fever and aching as if I had been pummelled by a boxer. I was in near coma and felt my life was ebbing. Nothing seemed to have mattered at the time.  

I couldn’t believe what I saw. Was I dreaming? I had dreamt quite a lot and it was becoming increasingly difficult for me to separate dreams from reality. This time I knew it was real. The road was a pothole filled earthen stretch. Some of the potholes were deep enough to swallow a car if it rained. Here and there, were traces of tar as evidence that the road was once tarred. No wonder when I was rushed into the hospital, half alive and half dead, I had thought that I was on my way to Purgatory (a place between hell and heaven). It was amazing that I survived the ride! The hedges on both sides were rough and the adjacent lawn was over grown. Empty pure water sachets and tiny pieces of paper littered its surface. The flowers were withered and interspersed with ugly weeds. 

I quickly took my eyes from the window and began to explore my room. It was a big mistake! The room was smelly and scruffy - dirty walls and curtains, worn out floor tiles with missing pieces and cobwebs on the ceiling. The aluminium coating on the drip stand from which hung the infusion had peeled off in several places exposing its horrible looking rusty inner core.

    Now I was feeling very bad again. I felt an urge to empty my bladder. My nurse had asked me to press the call bell button anytime I needed assistance. I did once; waited about two minutes; then twice in quick succession and waited for a few more minutes. Still no one came. I pressed furiously several times in a row. I could hear it ringing at the distance. About three or more minutes later a nurse strolled majestically into my room and without asking me what the problem was shouted, “Old man, why are you so impulsive? Why do you want to bring down our ceiling with the bell?” “It’s too late now, nature has taken its course,” I replied calmly but badly shaken. I had done it on my bed and was reeking with urine. “There are no more bed-sheets and I am afraid you’ll have to swim in your urine until we get a new set from the laundry tomorrow,” she announced without any compassion. I didn’t bother to ask for my pyjamas to be changed. What use would that be lying on a urine soaked bed?

A few minutes later when I overheard another attendant raining abuses and curses on some patients in the general ward, I knew my nurse was an 'angel'!  “What kind of hospital is this?” I asked myself. The doctor provided the answer the following day. 

Resentment was rapidly welling up inside me, reversing the progress I had made. The drip set now removed, I could move about freely and started with a visit to the toilet. As I opened the door, a foul odour greeted me. The toilet had not been flushed for God knows how long. From the empty buckets in the room, I knew there was no water. Instinctively, l held my breath, shut the door as fast as I could and staggered back to my bed. Just then, the doctor came into my room. When he finished examining me, I expected he would discuss his findings with me. “I’ll see you again tomorrow,” he announced and walked away before I could ask any question.

My heart sank. Confused and dejected, I thought to myself, “This is not a hospital in which I can be nursed to health. If the journey to a hospital should be the start of a trip to heaven, I certainly would not like to begin it in this hospital. I would love a hospital with a heavenly road - well paved, with well-trimmed hedges; manicured lawns and beautiful flowers. I should be in a neat and tidy room; have well maintained equipment; nursed by kind, loving and caring people with smiles on their faces. I would love to have sweet, musical and gentle voices talk to me in whispers and serenading me so I could begin to appreciate the daily and unending concert of heavenly choirs even while in transit – not the distractions of the rude and uncaring attitude of dissatisfied and grumbling workers. My choice hospital should not let me think of my journey as the last lap out of this terrible world but as the commencement of a beautiful trip to a new and wonderful environment called Paradise!

It crossed my mind, “Is this the reason why many rich Nigerians are flown abroad to die?” If there are no hospitals to nurse them to health, there must be hospitals out there comfortable enough to die in.