Monthly Archives: February 2016

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.


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.


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.


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.

Don’t Sweat the Small Things

Sometimes in life, we allow small things which on their own are not significant to add up and turn into a massive problem. I speak from experience.  I am a creature of habit so I like things to be a certain way. To a degree, I do have obsessive compulsive traits. That is not unusual in a doctor. It takes a certain type of personality to go through medical school and then to work in hospitals and face all the horrors that can come with the territory. When I was living on my own, it was easy to use those OC traits for the good. Everything had its place in the little space I had. No mess was left where it was. Everything was clean and orderly. My personal life was organised to a T. In direct contrast, my professional life despite all my best intentions often felt out of control and at best, it was an organised chaos. Dealing with humans and ill-health is by its nature very unpredictable. You do all you can do and things get worse in some patients. In some patients, you barely have to do anything and everything gets better anyway. Which sometimes makes me question exactly how much we as doctors are able to influence and if it has more to do with patients than us.

Anyway…my lovely ordered life was turned on its head when I met and moved in with my husband. He is the spontaneous type who makes ad-hoc plans and also changes them (or should I say ‘forgets’) without warning. He is so full of energy that he cannot be neat. When he makes a mess, he would rather clean it up later. Later being in a few hours, days, weeks or even months in some extreme cases. I used to get really worked up about these things and ended up cleaning up after him because it was too much of a hassle to nag him into doing it. Then I started to resent having to come home after a long day’s work to organise everything again or use up my precious days off sorting. Now I have swung the other way. I have become an expert at turning a blind eye. I refuse to see the mess and I will generally not tidy up if it is not my mess. So whilst I complain less and I try to let him get to it in his own sweet time, it hasn’t lessened the stress it causes in my mind. I will literally obsess about the mess not being there.

Whilst I generally get on with my fellow doctors and nurses at work, there is inevitably one who is like a thorn in my side. In my most recent rotation, there was one such nurse. I will call her Nadine. She is a senior nurse with a lot of experience – this is usually an asset but in her case, she thought she could tell me how to do my job. I am usually quite laid back and approachable at work but I am certainly no pushover. I can’t be because as a registrar I have to take overall responsibility for patients out of hours. Well, Nadine decided because I was a new registrar that she had to question all my decisions, mostly indirectly. This really riled me because the decisions that I made were either straight forward or those which were more complicated were discussed with the consultant as per usual practice. I found that lack of respect very irritating and at the start of the job, I had to avoid any contact with Nadine until I could detach myself enough not to care. Once I realised by talking to the other nurses that it was not unusual for Nadine to give rotating doctors a hard time, I was able to maintain professionalism by communicating what was essential and just tuning out the negativity. What Nadine (and I) felt in the grand scheme of things was insignificant as long as I did the job I was there to do and I did it well. By the time I left, I think she had gained a grudging working respect for me.

I guess what I am saying is that I have come to realise some facts of life. Main fact being that most of life is not within my control. Fact is that there are many small imperfections and it is not always possible (or maybe even desirable) to make them perfect. I don’t always find it easy to let those little things go but when I do, it is less stressful. As long as I control those things I can control and make life as good as I can within my little bubble, I can live with the little things. Life is hard enough without sweating the small stuff.