I have been on call, 24/7 for the last 365 days, no weekends no leave. Why? Because the community hospital where I work in cannot afford to pay many doctors at the same time. Why? Because the patients cannot afford to pay for basic healthcare services. Why? Because the economy is bad. And if they can't pay, how can you give them QUALITY healthcare?
I handle emergencies with rechargeable lanterns.
I site intravenous lines with my phone torchlight.
I consult in a room with no fan, let alone an A.C, and I am expected to rack my brains and make diagnoses, even though I see a large number of patients within a short period of time.
I have had to operate on patients with phone torchlights.
I have had to improvise an incubator with a CARTON for a premature baby.
I have had to use a suction bulb, instead of an AMBU bag or an oxygen delivery apparatus, to resuscitate a baby.
I have had to use 5 ml syringe to resuscitate a patient in shock because there was no infusion set [compare this to using a spoon to fill a bucket with water]
I have practiced for 3 years but my bank account doesn't reflect it. Why? Most of my patients are poor and I am forced to pay for their treatment. Fact!
I have managed diabetic crises without hourly RBS, let alone tests like SEUCr [compare this to sailing without a compass, or flying without a radar]
In the western world, CT scans, MRI, ECGs are obtainable in the emergency department. Largely because there's an effective health insurance scheme. But here, my patients can't afford 3 square meals, they cant even do low cost tests like FBC, MP and PCV [each of which costs approximately #500], so how can they afford CT scans and MRIs, most of which costs as much as 50k to 80k for a single test.
How do you want me to diagnose them right when I cannot do these tests to confirm my diagnosis? By magic or clairvoyance?
I am faced with these daunting challenges. And I am faced with two choices: to watch them die, or to use my brain, my raw clinical acumen, and improvise to make ends meet. Most times I get it right. But sometimes, who knows, I may not. Why? Because I am no f*g "mutant X". I got no x-ray vision! Neither do I have a magic wand.
So next time before anyone compares me, or any other Nigerian doctor, with the average doctor in the western world who has all kinds of " medical toys" at his beck and call, the person should do well to bring such a person and place him on a 24/7, 365 days call in this shitty hell hole and compare his mortality rate with mine. Only then can we have this talk.
Yes, there are incompetent Nigerian doctors [ I am working on an article on that ], but so there is in any other profession, both in Nigeria and in the west. Yes, even in the Western world! John Hopkins recently published a study which revealed that the third commonest cause of death in the U.S of A, 3rd only to Cancer and Heart disease, is doctors' error! That is in the United States.
So, contrary to what we may think, "misdiagnosis", "negligence", "incompetence" is not peculiar to "Nigerian doctors".
We should stop blaming "Nigerian health care workers" and fix our system. The government has a lot of work to do. And until we do that, it would be unfair, perhaps inhuman, to compare our health indices with that of the western world, and to blame our healthcare workers for supposed "incompetence", when it falls short of what is obtainable in the western world.
I want a situation where there's an effective health insurance scheme in place, where the average man in the street can afford basic healthcare delivery, where I can run as much lab investigations as I want without being afraid that the patient may not be able to afford it, where every patient has an ECG monitor by his bed side, where I can do CTs and MRIs even before taking full history, where I wouldn't have to improvise incubators with cartons, where I wouldn't have to operate with phone torchlights, where ......
This is what I want. But I don't have that luxury. So I try my best to make ends meet in order to save lives. You should really take a walk in my shoes.
I am a Nigerian doctor, I work under impossible conditions and still generate positive results. I walk with my head held high.
Written by a Nigerian doctor, Efe Ruke