Physician Heal Thyself

Yet another doctor has committed suicide recently. The 3rd in the past year in the UK that I know about. There are probably more. It is so sad. On the face of it, many people might think what do doctors have to be so depressed about? The public still imagine that being a doctor comes with a good job, good income and the respect of the population in general. Those of us in the profession and our loved ones know better. For most doctors, the work is relentless. The NHS is no longer fit for purpose. There are too many patients with less resources to care for them. There is more and more paperwork borne out of the NHS having too many ‘managers’ who analyse medical errors and harm and feel that creating another form to fill in will prevent future incidents. They fail to realise that what is needed is more funding to employ enough staff for the numbers of patients we treat. They fail to realise that they need to invest in their staff and make them feel appreciated and valued for their hard work and for doing more than they are contracted to do. They need to examine the levels of sickness and absenteeism and realise that burnout is real and so is depression. Above all, they need to realise that without preventative measures, doctors will continue to work themselves until they simply can’t.

Although the UK rates highly in a lot of economic and living standards indices, being a rich developed 1st world nation, it doesn’t do so well with mental illness. The positive news is that the UK had made it into the top 20 of the world’s happiest countries in 2017 (it was previously 23rd and is now 19th) for the first time since 2012 when the world happiness report started being published annually.

In March 2017, the Mental Health Foundation commissioned a survey to look into prevalence of mental health in the UK and to identify the factors about individual that make them vulnerable to suffering from a mental illness. It found that 7 out of 10 women, those aged 18-34 and those living alone had a mental illness. Only 1 in 10 of the whole population are happy most of the time. Women are 3 times as likely as men to suffer a mental illness. Stress is a growing problem. Majority of people suffer from either a generalised anxiety disorder, depression or phobia. Self-harm and suicide are not classed as mental disorders but are a response to mental distress usually cause by mental illness that has not been recognised and treated.

With these statistics in mind, it is easy to see why young female doctors are at risk of mental illness. Couple that with the fact that medicine attracts people with a type A personality who are high achievers and do not like to admit they have a ‘weakness’ or that they need help. I have already described working conditions in today’s NHS. No wonder so many young female doctors are struggling and every year, we lose a few to suicide. What I find particularly difficult with this is that when colleagues pay tribute to those who have died, there is always a huge sense of shock. Unfortunately, these women hide their illness so well that often even their closest confidants have no idea how much despair they are in. Their friends often describe them as ‘superwoman’, someone who ‘has it all’, always helping others, taking on incredible amounts and managing to ‘juggle it all’ somehow. They give so much to others that they forget to give their selves.

Caring. Freedom. Generosity. Honesty. Health. Income. Good governance. These are the things that increase happiness and promote mental well-being according to the Mental Health Organisation. I would sum it up as friendship. I think human beings are social creatures (yes, even the introverts) and need to have at least one good nurturing relationship. This is intrinsically linked to self-worth. Many people who have attempted suicide and lived to tell their story say that depression and anxiety eroded their self-worth to such an extent that they felt useless and that the world would be better without them in it. Depression interferes with rational ordered thinking. When it is severe, it is like being in a deep dark hole, full of doubts and lacking in any hope. Far from being selfish, I believe people who contemplate suicide are (in their warped thinking) being selfless and believe in that moment that they are un-burdening those around them.

So is there anything we can do to turn the tide? Most experts agree that by the time a person has planned to commit suicide, it is probably too late to do anything. The depression has taken over and has them fully in its grasp. Where we can make a difference is at a much earlier stage. We need to prevent people with low mood going on to develop depression. We need to be that friend who validates their self-worth. The one who lets them know in words and action that their presence is very much appreciated in your life. We need to talk about mental health more so that someone at the early stages of depression feels able to confide in someone and seek help. If mental illness is so prevalent, why do we not talk about it more? Why are we ashamed to say, ‘I am depressed, I need time off work to get treatment/rest to get better’? Would any of us feel ashamed to call in sick at work if we developed appendicitis, had to have surgery and needed a few days to recover? Just because mental illness is invisible doesn’t make it less valid. I think this ultimately is what will turn the tide. Talking about it, admitting we have a problem and asking for help early, taking time out now to prevent getting to the point where all hope is lost and we feel like we have no other option other than suicide.

If you are reading this post and can identify with the desperation that mental illness can induce, please reach out to somebody. Ask for help and support. If you are in the UK, there are some very good resources. Your GP should be your first port of call. If you are feeling suicidal, call the Samaritans on the free phone 116 123. Mind has help pages online that can be accessed at https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/helping-yourself-now/#.WX8lFojyvIU as does Turn2Me at https://turn2me.org/?gclid=EAIaIQobChMIvKCtr8Sz1QIVT5PtCh2D7QnCEAAYAiAAEgKyyPD_BwE. The Mental Health Foundation has some great guides for promoting mental wellbeing which can be accessed on https://www.mentalhealth.org.uk/your-mental-health . The app Headspace comes very well recommended for dealing with stress, anxiety and depression.

If you are a medic, there is a wonderful Facebook group called Tea & Empathy for peer support for all those working in healthcare. It was founded after we lost another one of our young doctor colleagues a couple of years ago and is a brilliant space full of supportive caring people. The Wales Deanery has published a booklet specifically aimed at helping medics cope with the stress of the job. You can access it here: https://www.walesdeanery.org/sites/default/files/bakers_dozen_toolkit.pdf.

Finally, I want to say to you all: You matter. You are loved. You are not alone. Be kind to yourself x

 

The Things I Never Knew About Childbirth and Having a New-born

I love to read so during pregnancy, I signed up to a few baby sites. They sent information through weekly and I read it all. I like to be prepared. I felt prepared but still I have had many surprises that I am going to write about. Mostly so when my daughter asks me in 25 years’ time, I will have a reminder of those ‘whaaaat?’ moments.

  1. The Pain: I already mentioned in previous blogs about birthing positions but it was such an eye-opener that I feel I must mention it here. First, I will acknowledge that pain is subjective and every woman experiences it differently. Having said that, the labour pain I felt was manageable despite being induced and on a syntocinon drip (which is meant to make it more painful). Until I made the mistake of lying flat on my back. Those minutes of being in that position where the most painful, second only to the post-birth examination. Upright was a million times better. Again, I’ll reiterate the hell the post-birth examination was. It was the single most painful part of giving birth and nothing to do with the baby. When the midwife had to examine me for tears/lacerations, it was all I could do not to scream the house down. After 8 hours of labour where I barely made a peep. Horrible. Steel yourself. Don’t be like me and mentally heave a sigh of relief once the baby is out. Hold it for that final examination to be over and pray you don’t need to have stitches.
  2. Inability to make decisions: even before the exhaustion and sleep deprivation peaked, I struggled with making the simplest decisions. Specially to do with the baby. First, I couldn’t decide what the room temperature was. I’d spent most of pregnancy feeling like I had a very hot water bottle strapped to me. I simply couldn’t tell if the ambient temperature was just right or if it was cold but that suited my constantly hot self. And it was important as there was a little baby who couldn’t tell me how she felt and she didn’t have much fat to insulate her in those first few weeks. I also struggled to decide what to dress her in, what to eat and when to eat it and when it was best to ask my mama to have her for an hour so I could try to have a nap. It took roughly 3 months to reset my brain into first gear. I’m nearly back to full capacity 9 months later.
  3. The sleeplessness: I thought I understood that a baby sleeps for short periods initially day and night but as time goes on, the intervals get longer and longer until you can manage some (few hours of) deep sleep. My baby never seemed to need much sleep. First two months, it was mostly 1-2 hours sleeps for her which means less for me as I was feeding, putting her to sleep then laying down and listening for too long if she was going to stay asleep. By the time I drifted off, she was beginning to surface so I was barely getting any quality restful sleep. Daytime was worse because whilst at night she would let me put her down, in the day time there was none of that (there still isn’t). She seems to have an internal sensor that is on in the day time. This sensor alerts her when she is asleep that she is being removed from human arms. As soon as her head touches down, her eyes spring open and all traces of sleep are gone. My mama was here for the first 6 weeks and she found a way to put her down for 1 nap a day. The idea was to give me the best chance of some sleep. Did I sleep? Not much. I would lie down and listen to even the minutest sound in the house. Eventually the exhaustion would come over me but usually I would have wasted an hour so that if I got 1 hour, I was lucky. By week 2, I felt like a zombie and that feeling didn’t leave until she was over 3 months old.
  4. The guilt: every time she cries, I feel guilty as hell. I can’t seem to rationalise the fact that babies cry. You can do your best and do everything you can think of and then some and still, they cry. Even when I ignore her and carry on with my essential tasks, my heart feels so heavy with guilt hearing her cry. Even when I can see she is faking it (they learn these tricks way too early) and there are no tears, I feel this overwhelming guilt. I spent the first few months focusing all my energy on her and avoiding her cries. So much so that I would forget to eat, drink or have a wee until my body was desperate. A couple of months after my mama left, I had to have a word with myself. It was only after I reminded myself that a few tears wouldn’t harm her that I started to get on with everyday tasks. In the early days when I was trying to get her to sleep in her basket, it was tough. She would wake every hour and I was exhausted. Lots of people advised just letting her cry herself to sleep once I was satisfied she was fed, had a dry nappy and the room temperature was just right. I struggled on and on until I thought I had to try it. That night, I settled her down in the basket and lay in bed next to her. She was up within the hour so I didn’t pick her up. I let her cry. She cried and cried and cried some more. She was not stopping! I lay awake listening to her and after about 5 minutes, I started to cry myself. I rocked her basket but didn’t pick her up. I left her for as long as I could (probably 15-20 minutes) and the guilt nearly killed me. I didn’t try that again for a month. Again, she just continued to cry until I gave in.
  1. The joy: so many little things that I always thought were cute in babies now bring me the most intense joy. When my daughter wakes up, searches for me and smiles the biggest happiest smile because I am there. When she reaches out her hand to touch my face as if to check I am real. When she laughs joyfully, as only children can. When she fakes a cough to get my attention. When she notices I am off-guard and pulls my glasses off with glee. When she grabs my sleeve/hip/belt as I walk past her highchair. When she splashes in the bath. When she comes back in from a walk with daddy and her face lights up on seeing me. My heart is always full to bursting with all the little joyous moments each day. And full of dread for when I must leave her and go back to work.
  2. The pride: Every time she does something the first time…the first social smile, the first proper belly laugh, the first babbles, the first time she rolled over, the first time she sat up without support, the first time she crawled, the first time she pulled to stand. I watch her figure out how do something the first time, the intense concentration on her little face as she works it out. I watch to see the triumphant expression on her face when she succeeds. I watch the surprise on her face when she falls over or bumps into something and how hard she tries not to cry. I was so impressed that when she was immunised on 3 separate occasions, she cried for less than a minute each time. Same with when she got her ears pierced. I know I am biased but she is such a brave little girl. Her joy, her determination to learn new skills and her bravery make me such a proud mama.

Our journey together is at its very infancy so I am certain I will discover many more unknowns along the way. Suffice it to say, I am loving motherhood and I cannot wait to see what our tomorrows will bring. What fun!

WWF, footie and Ayo

Three words you wouldn’t usually find together in one sentence. Ayo is a game played in Nigeria. In Hausa, the same game is called dara. I was taught how to play it whilst visiting a relative’s house and I fell in love with the game. One day, my mama travelled to Lagos and came back with one for me. It is one of the best gifts I have ever been given. It comes in a wooden case and inside are 12 holes. The exterior of mine was embellished with hand-carved patterns in the wood and it was beautifully stained a deep brown/red. It smelled of the oil used to stain it and the playing stones were seeds from a tree native to the South of Nigeria. There are many variations of it, as with all the best games. Classically, at the beginning of the game each hole (called a house) would have 4 stones and each player takes turns to pick up the stones of a house belonging to them and place a stone per house until you got to the last stone in an empty. After the opening play, the aim is to reform a hole of 4 stones which is then won by a player. This sounds dead boring but I promise you it is not. Because all the holes don’t start out empty, there is a lot of dropping and picking stones, forming big ‘houses’ (holes with lots of stones) and when you learn the patterns, you can win a lot of houses. A bit like Monopoly where the better player acquires houses and eventually the losing player has no house to play with. Watch it played here: https://www.youtube.com/watch?v=-1M7qf05ud4

Like I said, I fell in love with the game so I studied it and worked out all the winning patterns over time. Eventually, like a chess player, I could read the game 2 or 3 moves ahead of my opponents. My stepdad was a competitive and passionate man. In the evenings after dinner, we would sit in the living room, either playing Ayo or watching his favourite show WWF. When my Ayo first came, I wasn’t very good. Neither was my sister or the young cousins who lived with us. My stepdad was familiar with the game so in the first few weeks, he won pretty much all the time. My sister and I were competitive too so losing wasn’t easy for us but we took losing with grace. Not my stepdad. He would whoop and fist pump after each round he acquired someone’s house. The more he won, the worse he was. He would goad us, laugh in our faces and even did this thing where he pretended to wipe your face. Oh, we would get so frustrated! I remember having to fight the tears so hard and I think I complained bitterly to my mama behind his back too. Bear in mind, I was probably 6 or 7 and my sister about 10 years old. However, cultural rules were strict and we could not behave badly when we won. Neither could we refuse to play when he wanted to. As the days passed and we lost game after game and had to endure his behaviour, our determination to become good grew. Slowly, we began to win more rounds. Then more matches. Happy days when we got so good that we won most of the time. The tables were turned. We tried to be respectful children but it was impossible to hide our victorious smiles. We sat politely but inside we were doing cartwheels and fist-pumping. We had a good old giggle as we lay in bed after lights out, relishing getting our own back. Before long, he grew bored of losing and lost interest in playing with us.

My stepdad didn’t watch a lot of TV but he enjoyed sports, wrestling in particular. WWF used to be on TV on weekend evenings. My sister and I became keen wrestle mania fans. Back in the day, we liked the Undertaker, Tan Tanka, Yokozuna, Bam Bam Bigelow and the Hart brothers (I forget the name of the cute blond one every young girl was in love with). As soon as the opening credits played, we would leave whatever we were doing and sit in front of the TV with my stepdad. My mama would shoot us disapproving glances and find somewhere else to be. There was something brilliant about the deep voice over the loudspeakers announcing each wrestler then their ‘theme’ music would be played and the wrestler would make their grand entrance to chants and boos from the audience. The Undertaker was for me the unforgettable one. He dressed all in black, never spoke, never looked up and had long greasy hair covering his face. His music was creepy and he came with a coffin! Woah! That blew my mind back then. I used to imagine he came with a coffin that had a dead body in it. On the rare occasion, he would glance up, his eyes shone with an other-worldliness. I was scared and excited in equal parts. On special fights, not only would he beat the opponent, he would put them inside the coffin. What?! Awesome!!!

My stepdad’s favourite WWF wrestler was 1,2,3 kid. Young man, slight frame but very athletic and won a lot of fights. I remember his name clearly because my stepdad would get very excited if it looked like his guy was in danger of losing. He would passionately bang on the table and shout ‘c’mon’ at the TV. When the excitement got too much, he’d be on his feet and would literally jump on and down as 1,2,3 kid got on the corner ropes and flung himself down at his opponent. In the excitement, he would forget his name and call him 1,2,3,4. That made my sister and I laugh so hard and we would try to correct him in between gales of uncontainable laughter. We needn’t have bothered, he couldn’t hear us over his shouting at 1,2,3 kid to finish the other guy.

Whilst on the subject of TV excitement, international football was something else we shared with my stepdad. The most memorable footballing moment for me was Atlanta ‘96, the Olympics when the Nigerian Super Eagles won gold. This was the Kanu, Samson Siasia, El Rufai era. The golden years of Nigerian football. The first few games were good but as we all started to believe in our team, the matches became bigger and bigger. The final few games were epic. The whole of Yola was talking about the Super Eagles and there was a festive atmosphere everywhere. On the evening of the final, everyone had plans for where they were going to watch. People congregated in homes that had generators so that if NEPA (electrical supplier) cut power, we would still see the match. Our home was one of the congregation points. There must have been about 20 of us crowded around the TV. Even mama had caught football fever by then. At kick off, there was absolute silence. It felt like all of Yola was holding its breathe. I cannot remember what the score was but with every goal, you could hear the cheers echo across town. The winning goal came very close to full time. I remember we were collectively leaning forward and whispering go go go! A genius footballer, one of our eagles got the ball and dribbled it past a few defenders and then blasted the ball into the back of the net. And we all erupted!!! I don’t think I have ever felt electricity like that since. Every cell in me was vibrating with joyous energy. The cheers kept coming all around the town in waves, late into the night. We were all screaming and crying with joy. There was hugs and kisses all round, even for my stepdad who didn’t do public displays of emotion as a proper Fulani man. Now that is one moment I will never forget. One of my fondest memories of my stepdad.

Primary Six

In the Nigerian school system, we spend 6 years in primary school. Majority of children would sit their common entrance exam for secondary school in Primary 5 and if they passed, would skip Primary 6 and go straight to secondary school. My mother was the type of parent whose kids would complete all six years whether they passed or not. So, although I sat and passed my common entrance in Primary 5, I knew I was coming back to Primary 6. We went from about 50-60 children in Primary 5 to less than 20 in Primary 6. Our classroom was in the administrative block, away from the rest of the classrooms. We felt very grown up, practically teenagers.

I was a precocious child, mature beyond my age. Despite being tiny back then, I was easily the most outspoken girl in my class. This outspokenness in combination with my natural exuberance and good academic record meant I was a shoo in for Head Girl, leader of the prefects. It still makes me laugh that I was head girl because I was smaller even than the kids in Primary 3. That didn’t faze me one bit. I loved the challenge!

Our main duty as prefects was to organise morning drop off, assembly and break times. We had to make sure all the children were lined up per class and that they stayed in line and quiet during assembly. As Head Girl, I would lead the team of prefects patrolling the drop off area and it was our job to tell the parents if they were unacceptably late and even turn them back with their children still in their cars. Looking back, I am not sure how appropriate it was for us to essentially discipline parents. Perhaps culturally the teachers found it too hard to be so strict and they left it to fearless Primary 6 prefects to do. We also kept discipline in the playground during break time. Children being children, it was so hard to get them off the swings and slides and back to class. We ruled with iron fists. Somehow, we wielded enough authority that the rest of the school listened when we spoke.

Being head girl was tough yes but in truth, it was fun. By Primary 6, we had a very close-knit circle of (girl) friends. We had a laugh from the time we were dropped off until we were picked up. The first couple of girls to come would wait by the drop off, forming a welcoming party. The next girl to come would be carried to class ceremonially on a 2-person arm-throne and then we would all return for the next girl. That way, every morning, we treated each other like princesses. We would chat non-stop in between assembly and lessons. For lunchtime, we all stopped bringing in food from home (being so grown up) and were given break money instead. We would leave school grounds and go and buy food. In Yola in the 90s, there was no such thing as fast-food. Our options were local food sold to workers. Our favourites were moin-moin (bean cakes) and we discovered a lady who sold fried yam and tomato sauce. I don’t recall what we talked about back then but I remember how much laughter there was anytime we were all together. We would eat our food, sitting on the veranda outside our classroom and watching the little ones playing in the playground. We would play it cool with the boys in our class, falling silent when they approached as if we were sharing deep secrets.

Break times for us grown ups was competitive games. We had outgrown the playground swings, climbing frames and slides. In vogue during our time were clapping games and next level hopscotch. The clapping games involved a lot of very fast precise movements done by 2 or 4 girls in tandem (the boys never played, they probably weren’t dextrous enough or were too busy kicking a football about) whilst singing a rhyme. Check out this video on YouTube (https://www.youtube.com/watch?v=gbmNYD_YjzY). Then there was the game called 10-10 (ten ten) or walle in Hausa. The rhythm was produced by clapping and it started out sedately with a leg kicked into the ‘playing field’ and could be done in twos or bigger groups. The player had to avoid being played out by kicking out a different leg to the rest of the players. A bit like rock, paper, scissors using legs. And the pace built and built until it became quite frenetic. Very addictive game. As Yola is so dry and sandy, it could get quite dusty but that didn’t bother us. Brilliant game!

It fell to me to organise our leaving party in our final term of school. I don’t think preceding years did much to mark this momentous occasion but my friends and I wanted to do something special. I went to the headmistress to ask permission to throw a party and she said yes with no hesitation. Our party was on the final day of school. We decided what food we wanted and went to the market one lunchtime to ask for prices. I remember writing the list and working out how much money we needed and who would cook what. A few boys agreed to contribute but mostly it was a girls’ affair. The boys thought it was too girly to have a party.

We were given use of a room and brought in a tape player with the current hits on cassettes. We made the room look pretty and spread out the food on a large table. There was jollof rice, coleslaw, fried chicken, cupcakes, lots of sweets and soft drinks. My sister even gave us the beautiful Barbie cake she had made in her Home & Nutrition class. With the music turned up loud, we ate, drank, danced and had the best time ever, oblivious to the boys looking on in envy through the windows. We scrawled messages of friendship in marker pens on each other’s school shirts and found corners of furniture to leave our mark on.

At the end of the day, after all the fun, as the school bell went one final time the tears came. We were all going to different secondary schools. Despite making promises to keep in touch, we knew it would never be the same again. In those days, no one had email access or mobile phones. Keeping in touch needed a lot more effort. To be honest, I have forgotten half the girls in the group but I vividly remember the sadness in my heart as I hugged each of them goodbye and watched them get in their cars and drive off. I haven’t seen any of them since then. I found one of the girls on Facebook but 20 years on, we rarely have anything to say to each other. Still, I had a wonderful childhood and a big part of that was school and the friends I made there.

Baby Now What?

I wrote about the day I gave birth (blog entry called Childbirth) and described the physical process. Harder to put into words is the emotional process that day and the next few days as my baby and I started on our journey together. I’ll start at the beginning. When I woke up bleeding that day, I knew Savannah (that’s my baby’s name) would soon be here. I was scared. That labour would be painful, more painful than anything I had ever been through. I was scared that when it came to it, I wouldn’t be able to physically push her out and might end up needing a caesarean section. I was scared that Savannah might run into trouble and have complications. I was scared that I was going to be a mother and I didn’t know if I’d be any good at it. The main feeling that morning was fear and anticipation. I could not wait for the scary bits to be over, to hold my baby in my arms, to be a mother.

I had a scan printout from 28 weeks of pregnancy which captured her face. The shape of her face was clearly outlined and you could make out where her eyes and mouth were. I must have built up an image of Savannah in my head although when I thought about it consciously in the days leading up to her birth, I couldn’t quite see a clear picture. It was a bit of a shock when she finally popped out and the midwife bundled her into my arms. I looked at her and I couldn’t quite compute what she looked like. Not like my subconscious imagined because every time I looked away and back, I felt a dart of surprise that this was Savannah. The face I was looking at was the face belonging to the baby who was moving about inside of me just a few hours earlier. She looked like her dad and she had lots of curly hair.

I handed her back to her dad as I delivered the placenta and was examined for tears (thankfully none!) and given a little clean. When she came back to me, she was rooting about so I got into position and stuck her to my still-normal-feeling breast. Lo and behold, she opened her mouth and started to suckle. That almost blew my mind. It was the reality check I needed. My brain was starting to connect the dots. I had a baby. For real. Trying to get milk out of my boobies.

So, did I fall madly in love at first sight as people often describe it? Not quite. Naturally I loved her but it wasn’t a sudden flood of emotion. Perhaps it was the exhaustion of the day but it was all a little muted. I was dirty, exhausted and hungry. At my midwife’s suggestion, I mustered up all the energy I had left and shuffled to the bathroom, half hanging onto my husband as my mother held her granddaughter. As I stood under the hot shower (which annoyingly kept stopping whenever I stood still), I started to feel less drained. When I was washed, and dressed and smelling of the lovely shower gel I’d used, I had tea and toast (inhaled it more accurately) then I sat half asleep on the comfy armchair and watched my mama hold Savannah.

3 hours after her birth, the wheelchair was brought in to transfer me up to the ward where I was to spend the night. I sat in it and was handed Savannah. This was when I felt an almost overwhelming feeling of protectiveness. She felt so small, so fragile as I held her close. I pressed my face into the side of her face and felt the warmth seeping into my soul. Up on the ward, my husband and mother settled me in and said goodnight. With the curtains pulled around my bed, it was the first time I was alone with Savannah. As she lay in the cot, I lay down and closed my eyes, my hand resting on her cot. I found it difficult to sleep. Every fibre of my being was attuned to her and I was listening for the tiniest sounds from her. I didn’t sleep much that night (or any night for the next few months). When we were discharged, I sat in the backseat next to her and watched her carefully as her dad drove us home. This watching continued for the next few days until I got used to her face.

So, in the first few days, I felt warmth, protectiveness, love and fear. The falling in love bit came later. The first time I felt that exciting, blood surging, butterflies in the stomach love for her was weeks later when she started smiling socially. Every time she smiles, I feel a surge of in-loveness that makes my knees a little weak. When she smiles deep into my eyes, especially first thing in the morning, I fall in love all over again. She looks at me the way my mother looks at me. With an unconditional deep love that is incredibly humbling. When she reaches out her chubby fingers to touch my face or grabs me when I go past her highchair, I fall more in love. When she laughs with pure unadulterated joy as I tickle her or throw her up in the air, it’s love like no other. Now many months in, as Savannah learns to express herself and her personality is starting to take shape, I feel love for her like I never imagined I would love. I thought the love I had for my mother was unmatchable but it is. It is the same yet so different. Every day, I fall more in love with this innocent, beautiful child. Every day, I feel her essence seep into my very core and wrap itself around all that I am. I know that this love is the forever kind. The I’d take a bullet for her kind. The I am all in and so vulnerable to be hurt kind. The best kind of love. I am in love with her. Totally, madly, deeply.

Boarding School…In the Beginning

Here in the UK, when one mentions boarding school, you evoke the image of an old stately building sitting in vast manicured lawns with the occasional 200-year-old oak tree and outdoor tennis courts. The sort of private institution attended by the children of the wealthy and the odd scholarship working class kid. I went to boarding school. Of a totally different class. In Lagos, Nigeria. Yes, I was in Queen’s College Yaba (QC or QCY we fondly call it). QC is one of the best public secondary schools in Nigeria. It is also infamous for a breed of QC girl – stereotypically loud, someone who puts on airs and is into their material wealth. In reality, most of us are normal down-to-earth girls. However, there is a certain QC-factor many of us carry with us for life.

My mama is an ex-QC girl but my (older) sister was in a reputable military school in the north so we all expected that I would join her. I was all geared up for it. I sat their specific entrance exams and went on a week-long interview. Despite my best efforts, I didn’t make the grade (my parents weren’t military enough apparently). Luckily, I did well enough in my national common entrance exam to have been offered a place to Queen’s College. As my mama considered whether to appeal against the decision of my sister’s school to change the rules after a gruelling recruitment process (which I excelled at), I had one of my vivid dreams where I saw me checking into QC. Weird because I had never been or even seen any photos of the school. It felt like a vision of my future and I told my mama I was happy not to fight for my place at the other school. I was going to Lagos.

We got to Lagos a week before and had to go through a series of tedious administrative processes…full medical, bank tellers, school uniform outlets, book purchases. Mama even braved the markets (she hates markets) to buy the endless required items on our many lists. I was excited and nervous and already, I missed my sister and home. A big positive was that my grandparents still lived in Lagos then and their home at least felt familiar. On that first Saturday, we all had to get to QC before 6pm. We left home after lunch (which I barely ate) and as we got onto the 3rd mainland bridge, we hit traffic. My heart sank into my shoes. I felt a darkness descend over my soul and I thought I was going to be sick. To make matters worse, the traffic was all headed in the same direction so the agony of anticipation was prolonged.

It was utter chaos. Have you ever been on a farm when cattle have to be corralled and branded/tagged? Being the granddaughter of a farmer, I have and I can tell you it’s not a nice scene. Cows are not docile like sheep and I think they are cleverer too so once the first lot have been through, they moo a message back to the herd and the rest all go a little wild. They start to struggle against the humans try to feed them through the metal paths. Their nostrils flare and dribble and their eyes take on a wild rolling look. It is not pretty! Combine that with all the shouting men, the mooing, the smell of branded flesh, cow pee and poo…you get the picture. This was how the scene I was faced with felt.

Parents were giving up waiting in the long traffic queues leading up to the school gates. There were people everywhere in the streets surrounding QC as everyone but the drivers disembarked and grabbed luggage, buckets, school bags, brooms and mops. Irritable drivers honked as people staggering under all that load wandered in and out of traffic. Older students spotted returning mates and there were squeals of joy and excited chatter as friends were reunited after the long summer holidays. In the middle of all the chaos were the newbies. Me and my fellow JS1 girls. Silent, quivering wretches whose young faces bore expressions of doom. In our shiny new uniforms and shoes. Taking it all in, dragging our feet, praying for salvation. At least, that was how I was feeling.

First, we had to find the administrative block and queue to submit bank tellers, get registered. All JS1 queued to get to a marquee to be allocated a house (I drew orange for Obong House and not the blue for Obasa my mama had been in). Then we had to find our House station where we had to hand over the cleaning supplies, sign in and be told our dorm and then the senior girls had to root through our bags to fish out any contraband. This process took ages! By the time I was fully processed, it was approaching 6pm and the dean had reached a climax as parents/siblings said goodbye and tired senior girls continued to check everyone in.

I had to make two trips across (dormitories, dining hall and library were separated from the administrative, class rooms and staff quarters by a gated wall). I found Obong 6 (dorm 6 in Obong House), dumped the first lot and hurried back to find my mama. It was time to say goodbye. I gave my mama the longest hug, inhaling her familiar smell and fighting back the tears the threatened to fall. Mama was misty-eyed too as she kissed me and promised to be back on visiting day 3 or 4 weeks later. I gathered up my bits and pieces and with leaden feet turned and crossed over, using up all my will power to stop myself running back and begging mama to take me home. At the gate, I turned and waved one final time and I swear I felt like a dead man walking to his execution. I made my way back to Obong house, claimed an empty bunk and sat on it.

I don’t know how long I sat there for before Zara, my lifesaver found me. Zara is actually my mother’s second cousin but for ease of explanation, in QC she was my cousin. She was a senior girl, in SS1 when I started in QC. She found me in all that confusion and gently guided me through the process of finding a mattress for my bed and making the bed, finding an empty locker and arranging all my belongings in it and putting my bathing things together in my bucket. She sorted out my life and earned my eternal gratitude and then she disappeared back to her House (Obasa, on the opposite side of the dorms). I can’t remember if I had dinner that evening but I remember meeting the other junior girls. The JS1 girls all looked as lost as I did and that made me feel a tiny bit better. I was relieved when it was lights out. As I slid into bed onto my crisp new sheets in my crisp new nightie, I was overcome with sadness and homesickness. I didn’t think I could bear it. I wept into my pillow until sleep swept me into oblivion. I wonder how many other JS1 girls did the same?

Childbirth

I did it! Au naturel thanks you very much! I was so worried that my android pelvis would not be able to naturally deliver a baby, especially a baby who wasn’t small. Of course, had I been incapable of pushing the baby out, a caesarean section would have been okay by me but I really wanted to do it the ‘normal way’ so that I could get on with bonding with my baby and be back on my feet as soon as I could. The day before I had the baby, I had a scheduled scan to make sure the baby’s growth was on track. Everything looked great and her estimated weight was not a small baby. Worse, looking at the growth charts, if she carried on growing at the rate she was, she would be a large baby by the time I got to 40 weeks. I said prayers and I spoke to the bump for the rest of the day, urging her to come on out as soon as she could. Anytime now. I was 38 weeks pregnant. I felt huge and ungainly. I was getting breathless with minimal exertion. I wasn’t sleeping well. Mentally, I was geared up for labour. I had completed my antenatal classes and I knew what to expect including the ‘ring of fire’. I just wanted to have my baby in my arms. That night, just before midnight, I had the strongest craving for an ice lolly. Of course, there was none at home so I roused my hubby and we went to the nearest 24 hour shop.

I woke up in the wee hours of her birthday, bleeding lightly. I had lower back ache that had been there for days but otherwise I felt fine. Baby was moving about as usual. I called the delivery suite and was asked to come in. I had to tell the hubby a few times to get a move on, get ready and drive me to the hospital. I think he was completely unprepared for me to have the baby that day. My mother on the other hand only needed telling once. She was dressed and downstairs. The waiting hospital bag was placed in the boot and off we went.

In Triage, the baby was monitored and she was absolutely fine. I was examined and my cervix was 3cm dilated and thin – the official landmark marking the start of active labour. I got a room and settled in. 3 hours later, my cervix remained at 3cm and the obstetricians were twitchy because of the bleeding so I was induced and then placed on a drip to help the labour along. As the drip was cranked up, the contractions intensified. At first, I was comfortable enough sitting up in bed, doing controlled breathing. 2 hours in, I started to walk about and that helped too. Another examination and I was 6cm dilated. Progress. Another hour and I needed the gas and air. I think it helped but to be honest, the light-headedness was all I could process. I kept feeling like I would fall so I had to stand by my bed and hold onto the headrest. I ended up kneeling on the bed, grabbing the headrest for balance. As a side note to those of you who are going to have babies after reading this, the pain of my contractions was 10x worse whenever I lay on my back to be examined. My advice is, being upright either standing if you can or kneeling on the bed. It honestly made a huge difference in the experience of pain.

5 hours after the drip was started, the pain changed from a rhythmic contracting vice-like pressure to a feeling I can’t describe. I felt an uncontrollable restlessness come over me, like I needed to ‘do something’ other than just breath and bear the pain. This was the urge to push. I told my midwife who tried to keep my mind off the feeling as she was expecting it to be another hour before I was fully dilated. I could keep still and I said again, I think I am going to start pushing. She examined me this time and in a surprised voice, she said ‘You are ready to start pushing.’

My first few pushes were ineffective. I felt like I was pushing but I was directing my energy wrong. When I finally bore down and pushed into my bottom, praise came from my midwife. She wanted more of the same. With my husband’s arm to hold onto, I remained kneeling and I pushed with everything I had with every crushing contraction I got. About 15 minutes in, I suddenly thought ‘what if I can’t do this despite my best efforts?’ I watched the midwife examine me and asked if I was making progress. She was all smiles. ‘Oh yes’ she said. ‘ Do you want to feel the head? It is full of hair!’ I declined to release my hold on my hubby. I was still woozy from the gas and air but I was given a new lease of life by that news. ‘Ok baby,’ I whispered to the bump. ‘We can do this.’ I was sweaty and dizzy but I was also very excited. It was nearly over. I pushed and pushed until every muscle in my body was trembling from the effort.

Then came the ‘ring of fire’. This is the bit where the head comes out and your pelvis is at maximal stretch plus your perineum (the skin) is stretched to tearing point. It feels like you are on fire down there. Luckily though, this is when you don’t have to push any more. You just ‘pant. Breath, breath.’ The fire subsided somewhat as the head came out then it felt like everything paused for long moments then more stretching (baby rotates, shoulders born, one at a time). Then a hug gush as the rest of the baby and fluid pops out. She cried as she hit the mattress and I felt the biggest lift. All the worry and stress was gone. We had come through labour. The relief was a little premature. The placenta came a few minutes later. Then the midwife had to examine my insides and perineum for tears. Now that hurt. Like I was being stabbed by a thousand sharp knives. Despite the gas and air the midwife made me have before. Good Lord! I was prepared up to the point. That pain is the only pain I remember with clarity today. The contractions, the pushing, the ring of fire have all faded away mentally but I am scarred by the post-delivery inspection.

As I stood on shaky legs in the shower under a warm spray, watching the blood wash away, I could not believe that I was now a mother. This morning, I had a large bump. Now, I had a jelly-like bump and a baby to hold. Back in bed, I drank tea and ate buttered toast. Never had a simple breakfast tasted so delicious as I stared at the bundle my mother held. ‘This,’ I thought to myself in amazement, ‘Is the first day of the rest of my life.’

Here We Go Again

lilywhite

The past few month has seen a lot of talk about racism in the media. Particularly in relation to the Oscars. With it, a lot of eye rolling and people saying they are fed up of black people going on about discrimination and playing the race card. What about the Muslims, the gays, the transgender, the browns, the women, the poor? It is a constant source of irritation and sadness for me when these discussions kick off and people start shouting at each other. My first issue is no one wants to listen. This is why racism and the many other forms of discrimination continue to thrive in our societies. Societies that are ashamed to admit a lack of progress and would rather hide what they consider dirty laundry out of view. As if out of sight is really out of mind. Well, it is humanity’s shame and face it we must. Because if we don’t face it then we won’t ever fix it.

On the Oscar issue: yes, it is inherently racist. Why? Because up until recently, majority (94% according to many internet sources) of those who are eligible to nominate and vote for the winners are white and ¾ of those are men. Human nature, and this is evidence-based, is such that if a selection of talented actors/actresses/directors is presented to a person, the voter will look for common traits to identify with the nominees. The easiest trait to identify: skin colour, gender and other physical attributes. So stands to reason that if 94% are white, they are more likely to nominate and vote for white people. There was a blog by a young black woman who works in the entertainment industry published on mumsnet. The reaction was one that had my gnashing my teeth. Many (white, brown and black) suggested that it was not the correct forum for such a discussion. I was dismayed. If mothers are not the people who need to be educated about the ills of discrimination and who need to be encouraged to socialise their children into seeing beyond colour, then who exactly is going to be the catalyst for change?

mother and child

I cannot for the life of me see which other group yields more influence when it comes to such a fundamental change. As a soon to be mother, I see it as absolutely my job to teach my child to see the inner qualities of every person they interact with and judge them based on their actions and words and not the things over which they have no control over.

queue jump

In Nigeria, there is blatant racism still. The fairer your skin is, the more socially desirable you are in many circles. The more foreign your English accent, the more educated you are perceived to be. Being resident in Europe or America or Asia elevates your self-worth. Doesn’t matter if you do the most menial of jobs abroad or have very little education over there. I was born in Nigeria, left as a teenager and I have now officially spent more of my life outside of Nigeria then in it. I see the discrimination clearly. Sure I am a highly educated and successful professional but most of the strangers I interact with don’t know this. To many it is all superficial. I get asked my opinion on things that are well outside my area of expertise and even when I am confessing to having little knowledge, my opinion carries weight. I get better customer service because of the way I speak. I get less abuse from those who like to abuse their positions of power – the police, road safety, customs and immigration officers. When I go into shops run by foreigners, I watch how they treat ordinary Nigerians with barely disguised rudeness or contempt and how those Nigerians do not complain about it. I speak up sometimes to the surprise of those Nigerians and I get told I am ‘feisty or fiery or outspoken’ with amusement or admiration depending on the age of the Nigerian I am defending. I have been in situations where a non-black person has walked into the place, seen the queue of Nigerians waiting to be served and decided that their time was more valuable that the locals and cut to the front. I wait to see if the officials say anything, rarely will they ask for the person to do the right thing. If nothing is said, I am never afraid to tell the person that there is a queue and we were all in it.

The other manifestation is through skin bleaching. It is so prevalent in Nigeria and indeed many other societies. People, mostly women, spend a lot of money on creams and lotions containing dangerous toxins which ‘whiten’ their skin. Some of the more expensive products do a good job and give them fairer skin that looks natural and healthy. Most do not. It is so ugly to see the patchwork that results from some of these products. You see women prancing around with their face and neck a Caucasian skin tone, their arms brown and their joints black as nature intended. It is so unnatural that it sometimes looks like a comedic caricature. Sadly, for those who do it, they look in the mirror and think they look more beautiful. Heart breaking to me because some of the most superficially beautiful people on the planet are all shades of brown and black. There is nothing more beautiful to me than flawless golden or deeper brown skin. I see photos every day and wonder how those who bleach are unable to see the beauty in brown skin. Of course this is all about superficial beauty. Maybe that is where we fail. We are too preoccupied by the outer image and fail to see the beauty within. I truly believe that for a person to be truly beautiful, their soul, their heart and their mind must have a positive nature. That is why I find beauty in the eyes – a person whose eyes glow with love, happiness, kindness and warmth is a person I naturally gravitate towards.  That is why there is nothing more beautiful to me than a baby (human or other mammals). That luminosity that is unspoilt by life and its many hardships, that bright light.

name spelling

Here in England, racism is everywhere. I have a surname that has 3 syllables. Pronounced exactly as it is written yet many won’t even attempt to pronounce my surname. If I can get my head around Siobhan actually being pronounced as shee-von and Yvonne pronounced as Ee-von, then I do not see how it can be hard to say a name as easy as Ab-dal-lah or Jo-da or Di-ya. Working as a doctor on the wards, I have had patients say to me with surprise ‘you speak good English’ and I turn around and say to them ‘why wouldn’t I? English is one of 3 languages I was brought up speaking’. I overhear staff talking to non-native English speakers (those with foreign accents or limited English) very loudly, as if the issue is with hearing loss. I hear comments about those non-indigenous Brits being ungrateful for asking for what is routinely offered to their white British fellow patients. I see the relief in black and Asian patients when I say that I will be their doctor and I will look after them. I empathise with them even as I feel sad that I make them feel better not because of my medical skills but because of the colour of my skin and how they perceive that I can relate to them better or will treat them with more dignity.

I will never forget the first time I was racially discriminated against. I was in my 3rd year of medical school on my first hospital placement in an inner city English hospital working with a medical team. On the first on-call I did with them (on-call means being responsible for the new patients coming in off the streets as emergencies), I was seeing patients who were then reviewed by the qualified doctors. Of course, there is a triage system so medical students never saw patients who needed urgent care for things like an on-going  stroke, heart attack or acute asthma that needed immediate treatment before information gathering. Anyway, I was allocated an elderly Asian gentleman to see. I walked into the cubicle and introduced myself, clearly explaining that I would see the patient then get one of the doctors on my team to review. The patient did not protest but his 2 sons were affronted. They, in their high-powered suits, did not think it was appropriate for their father to be seen by me. They wanted someone else. I got my registrar and told him what they had said. He, being Asian like them, was angrier than I was. He marched me back to the patient and his family, informed them that I was part of the team and as this was the NHS, they would be seen by the first available medic. Their choice was me or going private. How awkward for me and the patient! They apologised and I got through the consultation. This happened 10 years ago and happens to this day. I applaud my registrar for his stance and anecdotally, it is happening less and less because people like that registrar were calling people out for their attitudes.

random search

I spoke in another post about the attitude the police have when they stop you as a black person. The approach is usually quite different – the black person is more likely to be treated as guilty of some wrong-doing until proven otherwise even where you are the victim reporting a crime whereas the white person is more likely to be treated as innocent until proven otherwise. Same as when you go into a shop, a security man (or woman) is more likely to follow around a non-white person than a white person. Same as ‘random’ extra security stop searches in the airports. Once, I got stopped for a random search twice in 10 minutes in Birmingham International Airport less than 100m apart. I was irritated and the lady was apologetic and wouldn’t meet my eyes. I pointed out to her that her colleague had just stopped me randomly too and in fact he was only a stone’s throw away. What was it she thought would have changed in the distance to her? It is a random search ma’am. Randomly because I am black you mean. She flushed and muttered an apology as I gathered my bags and carried on. Random. Racial profiling is reality.

So whilst I know that majority of white people are not actively racist, just as I know that majority of Muslims are not extremists, it is clear that as a black woman, I have more obstacles to contend with. Life is just that little bit harder because I was born with the colour of my skin. I ask for no special treatment. I just want to be treated the same as my non-black friends are. I want to be treated with respect and given my dues. I want people to judge me for what I have said and done (which I have control over) and not the genetics I have inherited. I want my talents to be recognised for what they are and not the physical package they come with. I want the same rights afforded to me by virtue of being a human being. I want justice. I want acceptance. I want to freedom to be me.

The Malay Experience

In 2008, after a short 4th year of medical school, I caught a flight to Kuala Lumpur. My first trip to Asia. Solo. I cannot remember how I came to choose Malaysia. I think I wanted to go to Asia, wanted an English speaking setting and importantly somewhere warm. Sri Lanka was another option but I didn’t know anyone there so Malaysia was the choice I made.

My mama as a human rights activist worked with an organisation with close links to Malaysia so she had been to visit many times and had made some good friends there. When I asked her for help, she was on it. She contacted her friends and asked whether any of them had medical connections in Malaysia. Fortuitously, one of her friend knew the health minister in Kelantan State. The only question was did I want to go to Kelantan, being the most conservative of states, quite ‘Muslim’ in its ways? Well, being a very modern Muslim I could see why some would question my willingness to be in a community that was rather more conservative than I chose to live my life. But I wanted an experience so I had no hesitation in saying yes.  Then I had to find somewhere to live for the month. Another one of my mama’s friends had a GP husband who was resident in Kota Bharu, the capital city of Kelantan state where the hospital was located. His home was too far to walk to and from the hospital so he organised for me to stay with his sister.

A few days before I was to fly out, he emailed to say that unfortunately his sister had a family emergency so she wouldn’t be in Kota Bharu (KB) for my arrival and he didn’t know when she would be back. Before I could panic, he went on to say I was welcome to stay at his and I would have to catch rides with his grandchildren to and from the hospital. So back to the beginning, I arrived in Kuala Lumpur on a warm afternoon. As I got off the plane after my 12-hour trip, I felt a queer tingle in my feet. I looked down and lo and behold my feet was swollen and my toes resembled little chipolatas. Remember I was only 22 years old so this was rather foreign. I wriggled my little sausage toes and poked both feet. Clearly, I should have mobilised more on the long flight. Noted. I made my way through baggage retrieval, immigration and customs and got to my hotel without incident. One of my sister’s uni friends generously came to find me later and took me out for dinner. The next day, after he kindly took me to get a phone and camera, we went to the Twin towers. What a sight! My jetlag was cured and I was suddenly filled with excitement. My first adult adventure in foreign country! The next day, my mama’s friend who had been instrumental in organising the whole trip took me to the famous Batu caves where we took in the impressive sights and also had one of the best Indian meals I have ever had.

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I think the sister in KB being away was a huge blessing in disguise. My new digs were rather luxurious compared to what I had been expecting. Dr R and his children were excellent hosts and made me feel at home. Bibi, their Indonesian housekeeper, was a godsend. She couldn’t speak a word of English and I couldn’t speak a word of Malay or Indonesian (a variant of Malay). It didn’t matter! She was a lovely lovely woman. She was short (average for the population) and portly for want of a better word. A little like Mrs Potts in Beauty and the Beast – very motherly figure. She always had a smile on her face and fed us beautifully. When I came home, there was always a jug of iced tea waiting to cool me down. It was very hot in the afternoons and the icy drink was like manna from heaven. I would change into my cotton Malay dress and throw myself down on the sofa in the upstairs living room which I made my own and down the cold fluid. That was all the activity I could manage until the sun went down and brought with it some refreshing breeze.42

The only cloud on the sunny Malay sky, apart from the relentless over 30-degree heat, were the mosquitoes. I was told soon after landing in KB that we were in the middle of a Dengue outbreak, spread by pesky mozzies. Now I am one of those who will get bitten wherever I go, regardless of covering or insect repellent. I like to say I have juicy blood. So what were my chances of contracting Dengue. Well, reassuringly (not!) I was informed the virus was only carried by the mosquito with the striped-back. I laughed about this – pray how was I supposed to tell whether a mosquito had stripes on its back? And if I had such keen senses, surely, I could just squash the little terrors before they bit me (whether they were the evil striped ones or not). Also I was helpfully informed that I was more at risk of catching Dengue Haemorrhagic fever in my first episode of the illness (I have since learnt that you are more likely to catch the severe strain on a second episode). Fabulous, I was at risk of catching a deadly disease (risk of death from the haemorrhagic disease was significant, 2-3 per 100). I got a few bites despite precautions but avoided Dengue fever thankfully.

The medical experience was quite opening. Based on the old British system, it was still quite paternalistic and the doctors knew best in most cases. A big population of KB was poorly-educated farmers and fishermen so many of the patients had no interest in being given hard choices. They wanted the doctors to diagnose them and tell them what was to be done. The nurses and healthcare assistants were also very much directed by the doctors and there was a noticeable hierarchy. The respect for doctors was palpable and that extended to us the medical students. To be fair, the doctors I came into contact with were respectful in return.

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I was with a group of female medical students, most of whom were indigenous Kelantanese girls coming home from KL for their elective. They were lovely girls. Very welcoming. They were my unofficial translators with the patients and did the job without minding how much of a drag it was.  They were all quite petite. I think the tallest was 2-3 inches shorter than I was. At 5 foot 6, I never thought of myself as tall but there I was being referred to as the tall foreigner. It felt rather nice. The girls all wore the hijab (hair covering with their traditional Malay dress) and were all shocked to learn that I was  Muslim as I wore the lightest formal clothes I could find and no head covering. However, they didn’t judge me. If anything, they seemed to be impressed by my independence. One of them, Nurul became quite close to me and I got to visit a more traditional Malay family and eat with them. Again, her family was so welcoming and humble that I wanted to adopt them all. Nurul had a small car which she generously used to take me and the girls to the markets, museums, cultural centre and even the seaside. Their culture was beautiful as was their food, music and natural environment.

Back in Dr R’s home, I made friends with the loveliest little girl called Ayin. His granddaughter, the youngest of his 3 grandchildren who I shared the school runs with. She was a tiny little thing. I think she was 4 or 5 years old and either she didn’t understand that I understood not a word of Malay or she didn’t care. She would come to my room after work and tell me all about her day (in Malay). She would share jokes and laugh. She would admire my little knick-knacks and tell me how much she loved my things. I would laugh with her, reply in English and invite her to look closer at my things and show her what new things did. She particularly loved my Malay silver butterfly earrings which I got there in KB and I would let her borrow them. One afternoon, me and my little friend were hanging out and chatting when Dr R came home early from his GP practice. As he walked past my room, he heard us conversing and was amazed. At dinner, he asked what it was we were talking about. It amused him to hear that I had no idea what Ayin was talking about but that we had these conversations. I was her ‘aunty’ and she was my little niece. Didn’t matter one bit that we spoke completely different languages but we were great friends which was all that mattered.

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The month in Malaysia flew by and although I was off on holiday to Thailand for 10 days, I was quite sad to leave my new family. I had an absolutely amazing elective in KB, met the most wonderful people and experienced healthcare with different levels of expectations and resources. I haven’t been back since then but I definitely want to take my husband and baby there so they can experience the great country that is Malaysia.

The Power of Dreams

My aunty forwarded one of those inspiring videos about life and happiness. One particular message struck me. It said something about having a dream then making it happen. Of course, it is easier said than done. It is not quite that easy to turn a dream into reality but those people who are the happiest are those who had a dream then put their all into making it a reality. I have many dreams. Through hard work and luck, many of my dreams are already a reality. I got into medical school, I graduated. I applied and got into speciality training and I am gaining experience as a paediatrician. I met a man with a big heart, fell in love and married him. We bought our lovely first home, a permanent abode after my many years of moving from flat to flat.  I fell pregnant when we were in good place and the baby has been growing well with the easiest pregnancy. I am getting ready to realise one of my biggest dreams – giving birth and being a mother. So yes, my bucket is overflowing.

This is about my professional dream.  I used to think I would be happy to graduate, specialise as a paediatrician, get a consultant post and settle down to a routine. With the recent political shenanigans and the more I work in the NHS, the more I realise I want more. I want more out of my life and I also want to contribute more than the daily grind. Don’t get me wrong, I know in my current role I do make a difference to lives. There is nothing more satisfying that when I have done a good job and I know that parent or child’s life has been changed for the better, no matter how small that change is. However, many days I look back after a busy day and think was that worth it? Those days which are all about paperwork and administrative tick-boxing exercises that contribute nothing except to some faceless manager’s satisfaction.

The part of the world where my life started (Yola) is lovely in a lot of ways but there is a significant poverty. In terms of economics but also in healthcare terms. Nigeria as a whole fails to cater to the healthcare needs of its population unless you have lots of money to go private. The North-East of Nigeria is one of the poorest when you look at health outcomes. In particular, looking at childhood. The statistics (where there are any) are shocking. Nigeria, for all its wealth, regularly features at the bottom of tables for health outcomes. We are in the bottom 5 for most outcomes including maternal and under 5 morbidity and mortality. For the non-medics reading this, morbidity refers to how much ill-health and disease (sickness there is) there is and mortality refers to how many are dying.

Mothers naturally should come in a low-risk group. Most should be healthy young women doing what is most natural – getting pregnant, growing a baby and then delivering the baby. Young children, although fragile because they are not mature yet biologically are despite all of that resilient on the whole and have bodies that are full of strong healthy organs with endless potential for healing. What we are failing to provide is basic care. Basic antenatal care, trained birthing assistants, hospitals to assist in difficult deliveries and facilities for emergency caesarean sections (surgery) for those women who cannot do it naturally. Infections, on the whole preventable and most totally treatable, cause a lot of the morbidity and mortality in Nigeria. Many of the other things we provide here in the NHS is simple supportive care, allowing patients own bodies to heal themselves in a secure environment.

So here is my dream. I would like to set up a women’s and children’s health centre. Big dream I hear you say. Yes, I am aware. It will be a huge task. I worked at the FMC in Yola for 4 months in 2012. I saw how much need there was and the things that were missing. I know a lot of the patients we couldn’t help were those who lived far away from town and did not come to us until their disease was too advanced for us to be able to do anything. Mothers died in childbirth because they did not have adequate antenatal care so predictable problems were not discovered until it was too late. Preterm babies died because they were born out of hospital in environments not hygienic enough and did not get simple breathing and feeding support and early treatment with antibiotics. Term babies were born too small because their mothers were undernourished and unwell with treatable conditions during pregnancy but were not diagnosed and treated. Very few of the patients we couldn’t help needed fancy expensive medicines or surgery. It was simply too little too late.

On the positive side, those that did come to us in time had better outcomes than those suggested by the statistics I read about on WHO and the likes. Those preterm babies born at FMC Yola thrived and majority survived until discharge. Sure, their progress was slower than here in the NHS because of a lack of basic equipment and provisions like oxygen and breathing support, working incubators, labs, fluid pumps, parenteral nutrition for those too young to feed by mouth or through the stomach. But survive they did because they are little fighters.

So what I dream is to provide all those basic things to the mothers, babies and children free of charge if I can manage to raise funds or at the very least at the smallest prices possible to give those with little the chance to quality healthcare. To go with that, I would like to provide an outreach service to those isolated villages. Run clinics, provide immunisations, antenatal vitamins and nutritional support, teach about prevention of infections and when it is vital to seek early medical help. Central to that idea is to train some of the villagers to provide safe simple birthing assistance, supportive care for new-borns and how to diagnose and treat the most common infections and provide first aid. All little things but added up should cut the numbers of mothers and children suffering unnecessarily and prevent the many preventable deaths.

My grandfather listened to me talking about my dream and was (rather unexpectedly) downbeat about it. He pointed out that it wasn’t as easy as I was making out. Actually, I know it will be difficult to do and as I have never done this before, it is a monumental task. There is so much to do to get this off the ground. However, here is my plan. I will start small and do this project in stages. I will deal with the complications as I get to them. A journey of a thousand miles has to start with that first step. I have taken my first step. I have dared to dream and I have written down my dream in black and white. Now onwards and upwards. Watch this space.