Port Harcourt, Rivers State, Nigeria (Winter 2018)
|Living Afloat by DoDD Brown, 2014. Port Harcourt, Nigeria|
In the last episode of one season of Grey’s Anatomy, a cyberterrorist hacks into the network of Grey Sloan Memorial Hospital and shuts down their cardiac monitors, CT scanners, elevators, and electronic medical records. The hacker demands 5000 bit coins and while the FBI tries to track him down, the doctors of Grey Sloan are helpless. They are unable to access any information about their patients’ medications, clinical histories, or previous vital signs. The episode ends with a dramatic scene of a doctor administering heparin to a kid who is already in an anticoagulated state. If there in no quick intervention, the child will bleed to death. Meanwhile, I will have to wait anxiously for the next season to find out what happens.
I have been following Grey’s Anatomy for four years. When my friend introduced me to the series, I had about five seasons to cover. I quickly discovered that the series was a quick getaway from the brutal reality of studying and practicing medicine in the tropics. Like every other medical student here, I watched Grey’s Anatomy with awe and entertained visions of practicing medicine in America; with blue scrubs, shining sneakers, and a defibrillator, ready to save the day. This vision is what drives most of us to try to get a residency in the United States, perhaps win a scholarship, and leave Nigeria for ever. Forget brain drain.
I never thought that by watching Grey’s Anatomy I would come to appreciate medicine in the tropics, but I did. Our scarce resources and limited technology have made us poor in fields like research and emergency medicine but remarkably resourceful in clinical medicine.
Teaching hospitals in Nigeria are very dysfunctional. Erratic power supply, incessant strikes, bottlenecks, embezzlement, and even the onslaught of blood-thirsty mosquitoes are just a few of the threats to the efficient practice of medicine in the tropics. But somehow we still manage to do it. CT machines down? The doctor still manages to make an accurate diagnosis of ischemic stroke and rules out hemorrhagic stroke. X-ray not available? The doctor makes an accurate diagnosis of pleural effusion, rules out pneumothorax, and immediately inserts a chest tube.
I found it surprising in Grey’s Anatomy that the doctors could not recall anything about their patients’ medication history. In the teaching hospitals in Nigeria, not knowing your patients’ history is a capital sin, punishable by an extended posting, a failed exam, or worse. For us, the clinical history and examination findings are the core of our practice. Your hands and your mouth are more important than a CT scan. There may be no electricity or, even worse, in a country where the patient pays for everything, the patient may not be able to afford a CT. Mercifully, a doctor’s hands and mouth are always available and comparatively cheap.
In medical school, the doctors teach us the rigors of taking a clinical history. Not clerking a patient before rounds is an error. The doctors do not wait to hear our excuses, no matter how excusable they are, but instead walk us out of the rounds. They will keep making corrections and giving criticisms until we learn the lingo and can give histories by heart, without using the folder.
So in Nigeria, a hospital computer hacker would not be a problem. We know our patients through and through; by touch, by smell, by heart. We do not need a computer to do these things for us. The medicine we practice here is still in no way comparable to that of First World nations, and I would hop at any opportunity to practice medicine in these places. Our medicine here is slow, archaic, and inefficient, and as much as we try to save as many lives as we can using limited resources, we still lose lives that could have been saved if we had the basics, like constant power.
The purpose of this essay is not to analyze the reasons for the inefficient practice of medicine in my country. I have heard all the analyses, but here we are. We still blame the government, our power is still erratic, and a CT machine is still a luxury in a teaching hospital. Rather, I wrote this essay because I was taught to write what I know. Although I have never seen an MRI scanner, and I do not know what it means to have an uninterrupted power supply, I do know that as a doctor in the tropics my hands and mouth are more valuable than technology. This is medicine as we know it; a brutal reality, but a reality all the same.
IFEDIBA NZUBE, MBBS, writes from the University of Port Harcourt Teaching Hospital in Nigeria. When she is not neck deep in clinical postings, she is in hiding with a good book. She has been published in Expound Magazine of Arts and Aesthetics, Kalahari Review, Brilliant Flash Fiction, and Hofstra University’s Windmill Journal.