Thursday 17 September 2015

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!