Category Archives: Culture

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

 

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.

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 Most Precious Gift

It is 2 days before Christmas and everyone here is busy buying last minute gifts, wrapping them, decorating their personal spaces, starting Christmas lunch prep and all the other little things that make these holidays so great. I too am getting ready for a very special day and it is not Christmas. Sure I am looking forward to Christmas. I am going to spend the day with my husband in Oxford on Divinity Road no less with some of my dearest family. It will be wonderful I am sure but the day I am looking forward to comes later (hopefully much later!). I am expecting my first baby and my due date is 2nd of April 2016. Which means that as I am 6 months pregnant now, anything could happen. It could happen any day. Being a paediatrician, I am more aware than most of the unpredictability of pregnancy, going into labour and childbirth. I wake up every morning thanking God that my baby is still in there, safe and warm, their organs developing in the proper environment. I go to sleep praying that the baby remains in there for another couple of months at least.

Since I found out I was pregnant, I have been doing a lot of thinking and planning. As you do. First I have been thinking about time. Am I going to be ready for this? Many people have told me it will be the hardest, best, most satisfying, life-changing, painful and joyous thing to happen to me. I have always wanted to be a mother. I think even before I knew I wanted to be a doctor, I wanted a little girl of my own. I know I will love my child with everything I have and I know I have a lot of stamina (you can’t be a paediatrician and not have a lot of willpower and mental toughness). What I don’t know is will I be a great mother? Like my mother, will I be able to balance love and discipline, teach my child what is right and what is wrong and bring them up to be a decent human being? I pray for that the most. To be as good a mother to my child as mine was (and still is) to me. My mama is definitely a cut above the average mother. She was a single mum yet I never felt anything was lacking in my life. In fact when my sister and I reflect on not having a father, we both think that we have lost out on nothing and probably gained a lot from not having that side of the family to influence us. If our parents had stayed together, we would not have been nurtured in quite the same way. We would not have been encouraged to know and speak our minds in the same way. We would not have known that having a great mum is not just enough, it is the essential ingredient in a happy childhood.

I have tried hard not to think of all the potential complications that comes hand in hand with growing a baby and then delivering it. But I cannot escape the fact that this baby will one day be ready to come out and I will have to get it out (or at least give it my best shot). When I was studying obstetrics in medical school, a lot was said about the shape of pelvises and the birth canal. Particularly about which are favourable shapes (those with beautiful childbearing hips like my beautiful sister) and which ones are not – the android pelvis (damn you all!). I sat in the audience wishing that was a class I had skipped. So yes, I have an android pelvis (boyish in plain speak) so nature is not on my side when it comes to pushing this baby out. Thankfully, both my husband and I have small frames and the predicted size of my baby is small meaning I have a fighting chance. I will give it everything I can when the time comes to deliver the baby naturally. Fingers and toes crossed.

I have started setting up the nursery and not gone mad buying gadgets and fancy things all the moms tell me were never used. I look to my sister as inspiration. Before she became a mother the first time, she was a bit of a shopaholic. She would buy all sorts of useless things because they caught her eye in the spur of the moment. Then she fell pregnant and it seems overnight found self-control by the bucket-loads. She became super-organised and wrote list after list and budgeted. She stuck to her plans and her son had everything he needed but nothing was done to excess. Brilliant! I have made notes and I would like to be just like her. I have lists too and every time I tick something off, my little heart does a jig. I am on the way to being a mother.

Before I hit 24 weeks of pregnancy, I didn’t dare to dream about actually having the baby. That is because medically, I know that few babies born before 24 weeks of pregnancy survive and those who do survive, do so often with a lot of complications and a poor quality of life. I was terrified of having a baby who was more likely not to make it than make it. I did not want to think properly of baby names, of delivery, of breastfeeding, changing dirty nappies or being kept awake at night. Just in case this wasn’t meant to be. I know there are no guarantees in life and anything might happen yet but the longer my baby stays in closer to that due date, the more fighting chance we have of having a long happy healthy life together.

Lastly, I am ecstatic that I get to have a little person that I have (without putting much thought into it) been growing to love and cherish for the rest of my life. This baby is literally eating from my food, growing off the nutrients I have taken on board, sharing my blood, and getting oxygen from the oxygen I am breathing in. My baby is swimming around (I can feel the slow sliding rolling movements and the occasional sharper kicks as I write this) within my tommy, in a little sac of clear warm fluid. Maybe the baby is sucking their little fingers, blinking their eyes, practicing becoming a football player. It is the most amazing feeling to think that as I sit here this little person is being built in the incubator that was once the size of a satsuma which is now larger than a watermelon, shoving all my other abdominal organs out of the way to make more space for the baby. I cannot wait to meet my baby when they are ready to face the world. The one thing I do not worry about is that I will be at their side from the day they arrive until I am no more. I cannot wait for the beginning of the rest of my life.

Mind the Gap

I watched a BBC documentary on The Taj Mahal Palace, one of the best hotels in the world located in Mumbai according to the documentary. It certainly looked the part. The opulence and the service was certainly worth the thousands a stay would set you back by. This struck me but what struck me more was the homeless families who made their home outside the walls of the hotel. The poor women who sold recycled flowers to make enough to feed their children. Where were the men who fathered those children I wondered? If the Taj was so successful, couldn’t it be charitable enough to feed its resident poor? How could the guests stand to walk (or more likely drive) in past those poor wretches into such luxury?

This sort of wealth inequity is replicated all over the world of course. The less industrialised the nation, the more likely you are to see scenes like these replicated. In Yola where I come from, this is very much in evidence. It is not unusual to see a huge mansion complete with high surrounding walls, an impressive iron gate manned by gatemen and perfectly manicured hedges sitting next to a hut, little more than a lean-to with dry barren land surrounding it and the inhabitant(s) unable to afford 3 square meals and clean drinking water.

When I was little, we would have bouts of feeling charitable and go visit one of those poor homes. Most of them are inhabited by single old women. Some were called witches because of their social isolation or maybe because of their disdain for some of our archaic cultural norms. Many are just poor and alone, without a benefactor to lift them out of abject poverty. A good proportion were quite old and really did need a hand. My friend and I would go in and give their hut a spring clean, refill their water pots (their lounde) and clear out accumulated rubbish. We would leave with their prayers for us and our mothers ringing in our ears. These women managed because they had neighbours like us who would go in periodically and help out.

That is one thing I love about Yola. By Yola I mean Yola town. Not the metropolis that is Jimeta which has lost most of its old school community (or maybe being ‘new’ never got a chance to form the same bonds). No one can deny that poverty is pervasive in the society there but actually, so is charity. It is imbedded in our culture to look after our neighbours. No one in Yola that I know of has ever died of starvation (malnourishment is a different kettle of fish). If your neighbour struggles to find a meal, they could simply turn up at meal times and they would get fed.

I remember one of our dear matriarchs who had little herself always fed more than just herself and her dependents. We always had food to eat at hers even though she was poor herself. When we went to see her before we went off to boarding school, she would ask for forgiveness (in case she died before we came back) and forgive us any infractions then she would rummage under her mat and give us some of her precious savings so we could buy something. We would demure unfailingly but we also knew we had to take it. Because not to take it would be seen as disrespectful and a sign we did not value her loving gesture.

This was 2 decades ago. Things are changing but charity is still very much alive. I am not sure whether the local children are still doing what we did back then but I sincerely hope so. Especially because as religion and politics become more and more of an issue and many of those in our communities claim to be religious. Well then. If that is true, true poverty should never be an issue. Islamically, Zakat is part of our core duties, one of the 5 pillars of Islam.

“Be steadfast in prayer and regular in charity: And whatever good ye send forth for your souls before you, ye shall find it with Allah”                                        Qur’an Chapter 2 Verse 110

For any Muslim who can afford to support their living themselves and have something left over, they should donate 2.5% of their wealth to those who are in need. This is Zakat. Imagine if in a society like Nigeria where an estimated 50% of the population (87 million) are Muslims. Now imagine that about half of them can afford to pay Zakat. If even half of those (20 million) contributed 2.5% of their wealth to a community fund that was well-managed, things would be so different. So I challenge the practising Muslims who preach all things good to sit up and remember this core duty of ours. More than a billion Muslims across the globe, a good proportion with enough wealth to alleviate poverty all around them. Let’s do it people!

The Cycle of Life Part 3

I could write and write about the many lives I knew that were cut short in their prime but I will complete the cycle with this last blog about one of my oldest friends. His name was Nabil. We probably met as babies but the first meeting I remember was when I was 15 years old. We had moved to London the summer before and were getting settled in still. My mama came home one day and announced we had been invited to have dinner the Ibrahim’s on Saturday. Who were they? I asked. She explained that they were old family friends. The parents were my grandparents’ friends and although their children were younger than my mother and siblings, they knew them well as children. I am told one of the kids had even stayed periodically with my grandparents in Lagos when they were going to school there. She told me that the oldest daughter had 2 sons, one my age and I was going to meet them.

Although we both lived in North London, it was quite a trek as there was no direct tube route and we had to go on 2 (or was it 3?) buses. By the time we got there, my nose, fingers and toes were frozen and all I wanted to do was curl up into a ball and sleep by a fire. I needn’t have worried. As soon as we stepped into their house, I felt my frozen cells begin to stir. It was always tropical in that house. Mum and Baba (the grandparents) like it very warm so there was never any danger of being cold once you got in there. I was introduced to the many adults, face after smiling face. It was like a mini-Northern Nigeria. All the warmth, the noise, everyone speaking Hausa. The boys were called down, Nabil and his little brother. They were instructed to take me upstairs until it was time for dinner. Although Nabil was friendly, he was definitely the quiet one. His little brother made up for it. He was very chatty, still pre-adolescent and full of excitement about life. Back then, he was quite small too. Very cute!

Nabil played us some music and told me about how they had only been in London for a year so were new to town too. He explained who was who in the family and we made general chitchat with his little brother telling us his fantastical half made up tales. We were in the same year of school and I was older by 2 months. By the time we got called down to dinner, we were friends. Over the delicious dinner cooked by Mum (his grandmother) and his mum, we talked some more. We exchanged numbers when I left. We stayed good friends over the years. We went to visit every so often and they made the trip across North London a few times too. We text occasionally in between visits. The next year, we talked about finishing year 11 and applying for colleges. I told him I was doing all the sciences and Maths because I would be applying to do Medicine. He said he wasn’t sure yet what he wanted to be so he was still thinking about which subjects to choose. We talked about where to go and I must have been convincing because I suggested for him to join me in Barnet College and he promised to consider it. He wrote down his address on a teddy bear notepad I had so I could sent him information when I had a confirmed place.

Common sense prevailed and he went to a college more local whilst I went to Barnet College. We went to see movies together and we even ate out at this stage, being all grown up at the ripe old age of 17 and 18 years. Every time we went out, he would insist on paying for everything and I would argue him down so we went halves. His little brother had grown into pre-adolescence by then and would irritate Nabil endlessly. His patience was great and he would repeatedly ask him to butt out of our conversations. I didn’t mind. I had a sister too and as the younger sister, I knew what it was like to be the little one. When we applied through UCAS for universities, he finally had a plan. He was going to study Maths. I was shocked. I mean, I was a straight A student and I got my A in Mathematics, an A* even in AS. I was no slouch when it came to it but to do a whole degree in Maths? I was agog! Why would anyone in their right minds do such a thing? He took my teasing in his stride. He said he didn’t have a profession in mind like I did and he knew he could use his generic Maths degree to do a wide range of things. I accepted this but I still thought him mad. He gave me that calm smile of his. ‘You’ll see’, he said.

As is the norm, we saw each other less when we went off to different universities. I went to Birmingham and he stayed in London. We probably saw each other once a year but when we did, it was like no time had passed at all. Ours was a very easy friendship. He would tell me about his ‘crazy’ Maths course. He seemed happy. I would tell him about Medicine and how much of it there was. How I realised more and more that what I knew was only a small fraction of how much I needed to know. He was openly impressed by how well I coped with it. His support and belief in my abilities were unwavering. Just like his friendship. I knew he was there somewhere should I ever need a friend. We text and Facebooked more than we spoke face to face. I can count the number of times we spoke on the phone in all the years.

Over the years, I would tease him gently about his girlfriend, or lack of. As the Fulani girl, I should have been more embarrassed to talk about such things but he was so shy about it. It became part of our friendships. I would needle him about ‘her’ and he would counter by asking me about my many boyfriends. I wasn’t shy about it. I had very little in the way of boyfriends but I told him of every encounter and how I preferred not having a boyfriend. He never admitted to any love interests but his brother was a more open book and I know there was somebody special at some point. He graduated and started an online sales platform. Next thing, he was talking about going back to Nigeria for his NYSC (mandatory youth service). He settled in Lagos. I happened to go the Lagos route once in his time there so I got to see him. He looked way too skinny and I was worried. As a newly-qualified doctor, I saw ill-health everywhere and was concerned he wasn’t sharing. He reassured me that he was fine. I didn’t need to doctor him. I believed him because youth corpers do tend to look the worse for wear during their year’s tenure.

The last time I saw Nabil was in Life Camp, Abuja in 2011. He happened to be visiting Abuja whilst I was there on a 10-day holiday. He was staying with a friend who brought him over. Again, I thought he was too skinny and he laughed it off. ‘Maybe I was always meant to be skinny like you’, he said. We chatted for an hour and he had to go. As we hugged goodbye, I felt how bony he had become. Life in Lagos was a hard one for a young man trying to start a business. My parting words were ‘You need to eat more. You should look after yourself better.’ His reply was a laugh and a ‘Yes doc!’ I stood at the door and waved until the car was out of sight. Not for a second did I imagine I was saying goodbye for the last time. The fuel subsidy crisis in Nigeria was the last thing we ever chatted online about. He became very involved in the demonstrations. I worried about his safety and he sent photos of himself and his friends at Lagos marches, looking happy and less skinny. He had found a cause to believe in. I was proud he was making a stand for a cause.

News that he was ill came out of the blue. I was in Yola, having taken a year out from working in the NHS to see the world. My mama got a call from one of his relatives saying that he was in hospital with a bleeding illness, cause still unknown. It was pretty serious and they were considering transferring him abroad as the healthcare available in Lagos was deemed inadequate. When my mother related the facts, I wanted to know more. What sort of bleeding? Was it related to a fever? Was Lassa fever the suspected cause? When my spoke to them again later, she was given more details. He had woken up that morning and told the friend he was living with that he wasn’t feeling too well. I think there was mention of a headache. He had been well the night before going to bed. His friend had gone with him to hospital and he either vomited or peed blood. The exact sequence is hazy but the gist of the story was that he had become sick rather quickly and what started out as an isolated bleed was now bleeding from multiple sources. He had been given a transfusion, we were told. He was conscious but seemed to be deteriorating.

When my mama related all of that news, I immediately thought the worst. When I burst into tears, she was alarmed. ‘He is alive,’ she said to me. ‘Don’t write him off.’ I tried to explain what I was thinking. I didn’t want to be a pessimist but unexplained severe generalised bleeding had a poor prognosis even with the best medical care. And he was not getting that. Not yet anyway. I had 2 professional experiences to draw on, both rather negative. My first experience of a patient with uncontrollable bleeding was in Malaysia on my medical elective in the 4th year of medical school. He was brought in by his heavily pregnant wife and a male relative to the A&E where I was working. He was very quickly diagnosed with Dengue Haemorrhagic fever. However, before any real treatment could be commenced, he went into cardiac arrest. With the medical students and his wife watching, the doctors performed CPR. It was horrific. He began to bleed from every orifice imaginable. His ears, nostrils, mouth. The blood was coming up the tube he had inserted into his lungs to ventilate him. The only part visible with no blood streaming out of it were his closed eyes. It was over as quickly as it began. It was obvious to everyone that he was far too ill to be saved. His wife was led away with the news.

The second experience was indirect. I was working in FMC Yola (Federal Medical Centre) and although Yola was ‘free’ from Lassa fever at the time, there were new cases being reported further south of the country. In fact, about 6 months before I had started working at FMC, there had been a patient with Lassa fever there and 2 of the doctors had contracted it from him. Unfortunately, 1 had died and the second had got to the Lassa Centre down south in time to be treated. He was one of the registrars on the paediatric team I was working with. So although he was okay, it seemed that mortality was quite high and only those who were diagnosed early and treated before they started actively started to haemorrhage (to bleed) were salvageable. Nabil’s story didn’t quite fit the bill because he had not complained of a fever and indeed had no fever in hospital. But it was my best guess with the facts I had and I feared the worst.

I pulled myself together eventually and prayed and waited with my mama. Next time we got an update, it was to say he was worse still, I suspect barely conscious at this stage. He was still bleeding despite all efforts and his parents were with him (they don’t live in Lagos). An air ambulance had been organised and he would be transferred abroad as soon as possible. We even heard he was being placed in the ambulance and I thought maybe there is some hope after all. That hope was short-lived. We got a call a few hours later to say that although his parents were in a flight to London, his air ambulance had never taken off. There were complications and unfortunately, he had not made it. I was so upset! All I could think is how his parents had no idea he had died and how they would have to make the return trip with that news weighing on them. To be honest, I have not asked them what happened exactly but it could only have been a terrible day.

I think the initial reaction of tears had taken the edge of my grief. I had started my grieving process before he was gone. I sat around in disbelief as my mama asked if I would be okay. As we made arrangements to go and visit his family, I could not stop thinking about how final death was. That was it for him, in this life anyway. I have no brothers so I whilst growing up, I found a handful of boys/young men to be my shining examples of decency in the male sex, my torch bearers when I felt dark about men in general. Nabil was one of them. Here was a gentle, calm, positive young man who believed in doing what was right, what was decent. He was respectful of God, his parents and our culture. He was a great friend and it was clear from the few times that I spent with him in the company of his family and friends that he was an all-round good guy. Losing Nabil was losing a little of the light in the darkness that sometimes surround men for me. Nabil was a good guy. Now he is no more. It took just over 2 days for a healthy young man in his mid-20s to sicken and die. Muslims would say it was time to go. I accept that but did it have to be such a horrible death? What did he ever do to deserve such an end? Why him?

The Cycle of Life Part 2

Mamie, my late grandmother, was from Mubi and Ribadu. Mubi is a large town in Adamawa State, even in the old days a thriving commercial town with good links to many other towns (that is until Boko Haram decided to move in). I understand that Mamie’s father was one of the successful merchants there and her home in Michika only came about long after her father died because Grannie, her mother was from Michika. Anyway, through one of her parents, she is partly from Ribadu too. My memory of Ribadu is of a little diversion on the road to nowhere, little more than a collection of huts that we got to by using dusty dirt roads off the main highways. Most Nigerians will recognise the name though because of the famous Nuhu Ribadu, arguable Ribadu’s most successful son. He was EFCC’s first executive chairman – Nigeria’s anti-corruption agency and suffice it to say, he went about his business fearlessly, bringing those previously seen as untouchable to account. He was loved by the masses and detested by the ‘elite’ who had enjoyed incredible daylight lootery for so long in Nigeria. He had to go on exile when he left office because of fears for his life. I digress, Nuhu Ribadu is a relative. Of course he is I hear the Nigerians cry. Everyone in Ribadu is related so therefore, he is definitely a cousin of some sort. My point is that before Nuhu Ribadu, Ribadu would have been a name no one except its indigenes noticed on the map of Nigeria. Now it is one of the household names in the country and no Nigerian should wonder about its origins.

The girl I want to write about was called Aishatu Mohammadu Ribadu. We called her A’i for short (pronounced Ah-ee). I don’t know how the arrangement came about but I remember vividly when she moved in with us. She was about to start secondary school. I suspect my mother offered to bring her cousin to Yola where there were more education opportunities. She was the oldest girl and named after Mamie so who better? She was as you would expect a little village girl to be at first. Timid and as quiet as a mouse. Pretty Fulani girl with her long curly natural hair. She was soon enrolled into GGSS Yola (Girls Government Secondary School) and on the first day, we lugged all the usual paraphernalia to the boarding school to check her in. I remember us walking around the dorms trying to find her allocated one. We did and when we had her things moved in, we said our goodbyes and left. I was in primary school then so it didn’t occur to me how hard it would have been for her. Not only to leave the shelter of her little village and move in with us but to then go straight into boarding school with girls from all corners of the State. She never complained about it.

She remained quiet for the first year or so and then by JS2, she came into herself. She joined the cultural club in JS3 or SS1 and flourished more with it. She came back after the first term of being part of the group and started to sing us their songs in her lovely voice. One chorus went:

Sai mu ‘yan Hausa cultural,

Daga makarantar Geeeee Geeeee (GG).

Mun zo ne muyi maku wasa,

Wasan mu ta Hausa.

Mun zo ne muyi maku wasa,

Wasan mu ta Hausa.’

(Translates roughly into: We are the Hausa cultural girls from the school of GG. We are here to entertain you, in the Hausa cultural way).

We particularly loved the bit where they introduced themselves and when she got to Aisha Mohammed (the Hausa-nised version of her actual name), we would grin out loud. Over the next year or 2, we learnt many of her songs (some by Sa’adu Bori, very X-rated for our age but who knew?). In the evenings when there was no electricity, we would lie on mats out under the stars and moon. She’d tell us stories about boarding school and we’d sing her songs. Her love for music grew and the first album she absolutely loved was Brandy’s Never Say Never in 1998. We all loved it to be fair but she learnt the words to the songs ‘Never Say Never’ and ‘Have You Ever’ early and would sing those songs so hauntingly that I can’t hear now even today without thinking about A’i. Just hearing someone utter the words ‘never say never’ evokes memories of A’i to me. I suspect looking back she was going through puberty and probably was in love for the first time. Being a shy Fulani girl, we never heard or saw the object of her affections. In fact, in all of her time, I only knew of one ‘boyfriend’ before she met the man who would be her husband. I cannot for the life of me remember him but I know she suddenly relaxed her hair, started to wear makeup and took extra care when getting dressed to go out.

When she graduated, she met Hamma Z (his nickname) and we all knew this was different. She would light up when his name was mentioned and although she was shy about it, she never hid that she liked him. I barely knew him then because I was in boarding school in Lagos myself and he wasn’t resident in Yola but visited periodically. I heard she was getting married shortly before the event and as it was the middle of school term and we had moved to London then, I could not be there. I spoke to her though and she told me how excited she was. She sounded it. After the wedding, they moved to Ashaka where her husband worked. It is a little removed so it wasn’t on the road to anywhere we would normally go when we visited. I never made it to her marital home (this I am still sad about). One summer holiday, I contacted her to say I was coming. She promised we would see each other as she was planning a visit to Yola and Ribadu in that summer.

One day, there she was. I think this was in 2002. She looked beautiful. She was always pretty but she was glowing that visit. When she spoke of her marriage and her new home, her eyes shone. I was very happy. I wondered if she was pregnant and asked her the question. A little bit of the light dimmed. She clearly wanted a baby and it had been over a year. She was worried. I remember telling her not to worry. ‘These things are written,’ I said. Her baby would come when it was meant. She smiled and said ‘You are so grown up Diya’ in Fulani. I hugged her and we sat by the car parking bays at home in Yola, sharing a private moment. Once again, the two Aishas reunited under the stars and moonlight. Before she left, she told me about how quiet it was in Ashaka but that she had made a few friends. She told me about her small business venture and how she was now making some money for herself and her plans to make it more than a hobby. She told me about her husband and how he was kind and worked very hard for them. When she left, I promised when I came next time, I would make the trip to Ashaka especially.

That next visit never came. I saw her when she came for Mamie’s death. Then I got a call from A’i a few months later excitedly telling me that she was pregnant and to tell my mother. Her voice was exuberant and I was ecstatic for her. We rejoiced briefly before she had to go. Call charges to the UK in those days were astronomical but she clearly wanted us to know because she was over the moon. It was very un-Fulani of her to call and talk about her pregnancy so early. Traditionally, Fulani girls would normally never say a word until their pregnancy was obvious to everyone. I guess she knew with us being abroad, we had to be told to know. It was the last time we ever spoke on the phone. We texted from time to time and she let me know everything was progressing fine. She said she had never been happier.

One morning, I got a call from my mama who had moved back to Yola. She said ‘A’i has a son’. Her voice sounded sombre so I immediately asked ‘and how is A’i?’ Mamie had died the year before and since then, we had lost a few other people. I suspected the worst as soon as my mama began to speak. She said Hamma Z had been informed that A’i was taking a little longer than expected to recover from her general anaesthetic. You see, she had had complications which meant they had taken her into an emergency caesarean section. Although my heart was still heavy, I was a little relieved. I was a medical student then so I looked it all up and was a little reassured. Chances of dying from a general anaesthetic are slim in a healthy young woman. Looking back, I think she had pre-eclampsia or something like that but as usual, in the Nigerian healthcare system, information is restricted so all we heard was that she hadn’t quite woken up. My mama promised to call when there was news.

I sat by my phone and waited. When the call came, it was what I didn’t want to hear. She had died. We found out later that actually she had died pretty much straight after the baby was born but that was kept from her family. In a panic, they pretended she was still alive but unconscious. I was in the UK and she was buried according to Islamic rites so I never got to see her. My mama went for the ‘funeral’ and reported Hamma Z was devastated but their son was healthy and beautiful. When the next summer came, I went to Yola and asked to be taken to him. He was living with his grandmother then and was nearly 18 months I think. He was beautiful, like my mama had told me. Quiet like A’i was at first. His aunties and cousins told me how he didn’t talk much or take to strangers. He came to me and sat by my side all visit, leaning into me when I wrapped one arm around him, despite not saying a word to me. They looked at me in wonder and said ‘he must know his blood’. I smiled and agreed. Yes, he must. I felt an intense love for him at that moment and I wanted to steal him away. I also wanted to burst into tears. I knew how proud his mum would have been of her little boy and was devastated she never got to meet him.

His father remarried after many years and A’i’s son was reunited with his father for good. Although I have only seen him a few times over the years because they do not live where I go on my short visits to Nigeria, his father and I keep in touch and I am told he is happy. He is an adolescent now and he is so much his mother’s son. I looked at the most recent picture of him I have and saw his smile. A’i’s smile. He has her eyes, her nose and her mouth. His colouring and demeanour is very reminiscent of her. I still well up at the thought he will never know her just as she never got to meet him but I am comforted by the fact that she lives on in him. If I ever get a chance when he is older, I will tell him his mother wanted nothing more than to bring him into this world. That I have never seen her so happy than when she was with his father. Nor heard her so excited than when she announced he was in the making. That he would have been the centre of her world. That she would have done anything for him. That he would have been the most loved little boy, the apple of her eye. I hope I get the chance to tell him all that. Life!

The Taboo of Domestic Violence

One of the great privileges of being a paediatric doctor is the frontline seat we have on humanity. Of course we only see this great variety of human life and get to share in their stories because the NHS is still at the point of need free. We get to see how the very poor live their lives and also how the more affluent live theirs. Stereotypes abound within medicine and on the whole they ring true but we doctors and other frontline staff are constantly amazed and shocked by the unexpected. Life is certainly unpredictable as a doctor in the NHS. This is one of the reasons why I love the NHS so.

One of the greatest sorrows I have faced is when I come across a mother and or child who is being abused by the man who is supposed to love her and protect her from the rest of the world. One of our babies has been taken into foster care recently because the mother is being abused and has chosen that option for herself and her baby. I wanted to weep (still do) because I cannot imagine the horror that the mother has gone through and must be going through to carry a baby to term, labour to deliver her beautiful baby and then feel she must give that baby up. Heart breaking! In this case, the abuse is on-going and the father of the child not only threatened the mother with further abuse, he has threatened to kill the baby if she takes it home. Isn’t there something we can do for her I hear you ask? Of course there are ways in which we can help her. We have offered her every viable option including the one she has taken: giving up her child for fostering or adoption. She weighed up her options and came to a decision to give up the baby. Some of us are worried this is not a rational decision but unfortunately, within the law as she is an adult without any mental illness to cloud her judgement, we have to accept her decision whether it appears rational or wise or not.

Unfortunately, this case is not unique. In my 4 years of paediatrics, I have seen far too many cases of domestic violence and its many victims. 1 is too many but there have been dozens in my short time in the NHS. Bearing in mind that I have only worked in 7 NHS Hospitals and have seen but a tiny snippet of what is going on out there, this is a massive problem that is rarely talked about. Even within paediatrics and obstetrics where this is a major concern, we only talk about it when we get a case. Then it gets filed in the back of our minds until the next unfortunate case. Today I want to highlight the evil that is domestic violence and in my little way encourage anyone directly or indirectly affected to do something about it. What we need is more awareness and everyone who can do something to do a little bit so we can get some change happening.

As you may know, my mother is a feminist so I have always been aware of domestic violence in its many guises and how ugly it can get. As a young feminist, it was always one of those issues I was passionate about and I even wrote a radio drama aged 14 on the topic which got aired in Lagos in 2000. From a very early age, my mother taught me to have zero tolerance to domestic violence. I have always said that the minute a man raises his hand to hit me, unless it is in retaliation after I hit him first, that relationship is done and dusted. Some of you may think this is extreme but if you knew what I know, you would understand that zero tolerance is the best way to go about snuffing out domestic violence.

In medical school (here in Birmingham), I opted to do a module on Domestic Violence in my 4th year of study. It was a short module but the quality of teaching delivered voluntarily by the staff from the local Women’s Aid was fantastic. It was sobering to realise that the knowledge I had from what was happening in my hometown in Yola was mirrored in Britain. Britain may proclaim how forward thinking it is but just the same with Yola in Nigeria, their response to domestic violence is still inadequate and there is very little actual protection for the victims. Majority of the work is done by the voluntary sector trying to safeguard those who seek for help. By the very nature of this service provision, victims do not have access to help and unfortunately, many will continue to be victims until they end up in intensive care or even worse in early graves.

Here are some facts and statistics from Women’s Aid (http://www.womensaid.org.uk/domestic_violence_topic.asp?section=0001000100220041&sectionTitle=Domestic+violence+%28general%29) by way of introduction:

  • Domestic violence is any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. It is not just physical violence. It can be verbal, sexual or neglect. It can be against a partner, a child or an older relative.
  • The vast majority of the victims of domestic violence are women and children, and women are also considerably more likely to experience repeated and severe forms of violence, and sexual abuse.
  • Women may experience domestic violence regardless of ethnicity, religion, class, age, sexuality, disability or lifestyle.  Domestic violence can also occur in a range of relationships including heterosexual, gay, lesbian, bisexual and transgender relationships, and also within extended families.
  • The majority of abusers are men, but in other respects, they vary: abusers come from all walks of life, from any ethnic group, religion, class or neighbourhood, and of any age.
  • Abusers choose to behave violently to get what they want and gain control. Their behaviour may originate from a sense of entitlement which is often supported by sexist, racist, homophobic and other discriminatory attitudes.
  • The estimated total cost of domestic violence to society in monetary terms is £23 billion per annum. This figure includes an estimated £3.1 billion as the cost to the state and £1.3 billion as the cost to employers and human suffering cost of £17 billion.
  • The first incident of domestic violence occurred after one year or more for 51% of the women surveyed and between three months and one year for 30%.
  • Amongst a group of pregnant women attending primary care in East London, 15% reported violence during their pregnancy. Nearly 40% reported that violence started whilst they were pregnant, whilst 30% who reported violence during pregnancy also reported they had at some time suffered a miscarriage as a result (Coid, 2000).

The commonest question people who have not been victims ask is ‘why doesn’t she leave?’ To understand the answer, you have to try to understand how they become victims in the first place. The typical victim starts out as a happy vivacious young woman, often pretty with very social personalities. They meet and fall in love with a man who at first glance is perfect. Often these men are older, more experienced who charm the girl with their confidence and assertiveness. Once the young woman/girl is ‘in love’ and moves in with the abuser, he (often he but not always) will begin to isolate the girl from her friends and family. It often starts innocently but becomes more pervasive. Often the man will complain about some character flaw in one friend and systematically will find a way of making her cut ties with majority if not all of her social support network. He will often start with small acts of violence like physical restraint if she wants to go out and he doesn’t approve, seizing her shoes so cannot leave the house or calling her ugly when she dresses in a way that she would normally and in the way he would have previously approved. Then once he starts to isolate her, he will chip away at her confidence and withhold praise so that she begins to modify her behaviour to please him and to get approval. To please him, she often has to isolate herself from her friends and family and cater to his every whim. Despite that, he will find fault with all she does and he will start by criticising her. Eventually, he will physically punish her for not doing what she should. Mentally, because of the slow insidious way of grooming her into becoming a victim, she starts to believe that whenever he abuses her verbally or physically it is because she has failed to do something.

Eventually, she is truly a victim and she stops to see herself as a victim and him as an abuser. She begins to blame herself for everything that befalls her and see him as her saviour. Most will come to believe their abuse is an act of love. What it often takes for her to begin to see her thinking is faulty is either when she ends up in hospital because he has lost control and beaten her so badly that he ‘allows’ her to seek medical help or she has children or other family members she feels responsible for and they get harmed. Even then, these victims will often go back time and time again. Sadly, some will go back one too many time and end up dead. Or their child will end up dead or permanently damaged. Here are some statistics to back that fact:

  • Women are at greatest risk of homicide at the point of separation or after leaving a violent partner. (Lees, 2000)
  • 60% of the women in one study left the abuser because they feared that they would be killed if they stayed. A further 54% of women left the abuser because they said that they could see that the abuse was affecting their children and 25% of the women said that they feared for their children’s lives. (Humphreys & Thiara, 2002).
  • The British Crime Survey found that, while for the majority of women leaving the violent partner stopped the violence, 37% said it did not. 18% of those that had left their partner were further victimised by stalkingand other forms of harassment. 7% who left said that the worst incident of domestic violence took place after they had stopped living with their partner. (Walby & Allen, 2004).
  • 76% of separated women reported suffering post-separation violence (Humphreys & Thiara, 2002). Of these women:

– 76% were subjected to continued verbal and emotional abuse.

– 41% were subjected to serious threats towards themselves or their children.

– 23% were subjected to physical violence.

– 6% were subjected to sexual violence.

– 36% stated that this violence was ongoing.

Lest I forget, I will mention the even more invisible group: male victims of domestic violence. I was heartened to see a poster the other day in a public toilet (female) offering male victims some help. This is just as important because we know that many perpetrators of (domestic) violence were once victims their selves. The man might be the victim in some cases. Learn to expect the unexpected.

So what do I suggest? For anyone who reads this, please share so that we can raise some awareness. If you suspect anyone you know might be a victim, please talk to them and point them towards the Women’s Aid website for help. Do not allow your friend or sister or mother to isolate herself. If you feel you are being pushed away and this is out of character for your friend, please persevere and remain friends with them even if it is only from a distance. Do not cut all ties as you may be tempted to do. Lastly, be watchful. Personally and for everyone you love. If you suspect something is amiss, draw them closer and be there so that if they need help, you might be that link that keeps them real and potentially saves their lives. If you are with a partner who is exhibiting some of the behaviours above, talk to someone you trust about it and ask for help. This help could come from Women’s Aid or even a trusted friend. If you are in a place where Women’s Aid or similar do not exist, turn to friends and family and seek for help early. No man is worth losing your dignity, sanity, health or life for.

Happily Ever After: a Disney concept or reality?

I am a huge Disney fan. My late grandmother Mamie introduced Disney to both my sister and I early. Every time she travelled abroad, she would return to Yola bearing delicious large variety boxes of chocolate and Disney Videos. She would watch the animation movies with us and being an adult, she got some of the more subtle humour and would chuckle away to herself. For us, it was about the songs and the princesses, about the girl finding her prince against all odds and getting that happily ever after. My sister and I knew all the songs and when we drew pictures, it was always of the beautiful Disney princesses with their tiny waists, long hair and dainty feet. It is not hard to see why I wholly believed then that every little girl would grow into a beauty, find her soul mate, fall in love and live happily ever after with lots of happy children. To make it worse, I was also an avid reader and there was nothing I loved more than fairy tales, all with their happily-ever-afters and when I became a teenager, I read numerous paperback romances.

Unfortunately for me, reality intruded at some point during adolescence. I was witness to women who had been beaten by their husbands, those who were practically enslaved and could not leave their homes on their husband’s say so and those who were in forced marriages, mostly young girls like me. I went from thinking that every little girl was destined to be happy to believing it was all a fairy tale and that there was no such thing as a happy relationship between a man and a woman. I still believed in romance but I believed that romance didn’t tend to last beyond the ‘honeymoon’ period of a relationship. I also learnt about the widespread deceit being enacted by adults who seemed blissfully happy in their marriages.

I could not find any aunties who could say to me that their marriages were truly happy. Even those who at face-value were living a fairy tale. I found out that many came to be content with their lot having gone through a lot of heartache and choosing to put up with the husband they got as opposed to looking for Mr Right. Most had considered leaving their marriages but on balance thought the security of a marriage outweighed their hurt and betrayal. Many had been cheated on, more than once. A good proportion were the main breadwinners in their household yet were still treated as secondary to their husband. They took the lion share of responsibility, financially and socially. They fed and clothed their children, they made sure the children attended school and did their homework. They sent the children to Quranic School and made sure they learnt to say their prayers and how to fast when the time came. They were the nurturers and disciplinarians. They did it all for little appreciation in many cases.

Unsurprising, I was quite cynical when it came to love. I had very few relationships that lasted longer than a flirtation over a week or maybe one date. Before I met my husband, I had two ‘significant’ boyfriends. I think it is pretty telling that both of those are guys I met on holiday and only gave them a chance because I was on holiday and in the mood to have some fun. The first one lasted about 7 months but the last 2 months wasn’t really a relationship. The second lasted about a year and I really did consider a real relationship with him but I had my rational hat on throughout and I could see how bad he would be as a potential life mate. It was clear to me that we were not in the same place in our lives so I broke it off, difficult though it was.

I was single for 4 years before I met George. By the time I met him, I was happy being single. Loving my space and the freedom to do what I wanted when I wanted, unlike many of my friends. I was happily alone and not at all lonely. The only thing missing in my life was children – I had always been sure that I would one day be a mother. I even had a plan for that. I wanted to take a year out to see the world then come home and work on my career for a few years. Then when I was comfortable, I would find myself a gay bestie who wanted children without the ties of a relationship and we would have a couple of children raised in harmony. Plan B was to go to a sperm bank and find myself some quality swimmers. The only concern I had was explaining to my extended family back in Nigeria who the father of my children was.

Of course, best laid plans and all. I was making plans and God had plans for me. Just before my year of travel, I met George and I was suddenly in a real relationship. George says he knew within a few days he wanted to marry me. It took me a little longer to be sure but I was pretty sure within 3 months that this was the man I would risk getting my heart broken for. We have been together for over 4 years now. We have, like everyone else, had some ups and downs. Some of the best times in my life have been in the past 4 years. Some of my worst too. Some of them because of the relationship, a good proportion nothing to do with personal life but for which I was glad I had George to lean on. I have grown up and learnt a lot about myself. I have found that I have infinite patience I could have sworn I didn’t possess. I am capable of much love despite hardship. I am capable of trusting a man. I still can get really angry but yet my capacity for forgiveness has grown immensely.

Question is: does happily ever after exist? I don’t have an answer. I wish I did. I know there are couples out there who give me hope. My grandmother and grandfather were not a perfect couple. I know Mamie (my grandmother) had to put up with a lot through the years and her patience had to have been great but I also know that Baba (my grandad) loved her and that she knew he did. He never forgot her birthday or their anniversary. He never passed on a chance to show her off. He loves all of his grandchildren lots but he has a special spot for the 3 of us named Aisha, after my grandmother. When she died, it was clear he was lost without her. She died just before their 50th wedding anniversary. He went into deep mourning and we were all worried for the first year after that he would self-destruct. He couldn’t bring himself to mention her name or talk about her for many months. When the raw wound finally began to heal, he would mention her with reverence and such love that it made me well up. Theirs was definitely a till death do us part affair. I cannot attest to how happy they were but I like to think it was happily ever after, at least for Mamie who died secure in her husband’s love.

As a relative newly-wed, of course I want to believe it will be a happily ever after affair. I only agreed to say I do because I had hope that it would be forever. No one goes into a marriage wanting it to fail. However, the facts speak for themselves a bit here. These are from the Marriage Foundation and the Office of National Statistics:

‘The Social Justice Outcomes Framework reports that 45% of children already see their parents separate. Unless trends change dramatically, nearly half of all children born today will not still be living with both natural parents on their sixteenth birthday.’

‘34% of marriages are expected to end in divorce by the 20th wedding anniversary.’

‘There were 241,000 marriages in 2010, near a 100 year low. Cohabitation rose from 2.1 million couples in 2001 to 2.9 million in 2010.’ Maybe because divorce rates are so high, people are opting more and more not to say I do?

There is a lot of good news though:

‘Those who marry have a far greater chance of survival as a couple than those who cohabit. 93% of parents who are still together when their children complete their GCSEs are married.’ In other words, couples that choose to marry as opposed to just living together are much more likely to stay together, have children and watch them grow to the age of 16 or older.

60% of marriages are expected to survive to the 20th anniversary.’ Isn’t that an amazing statistic?

‘16% of marriages reach the 60th wedding anniversary’ and ‘the average marriage is expected to last for 32 years.’ I think those are awesome stats, don’t you?

‘Among natural parents, 31% of those couples who were cohabiting at nine months had separated when the children were seven compared to only 12% of married parents.’ Meaning that married parents are nearly 3 times as likely to stay together for 7 years or more compared to those just living together.

‘Cohabiting couples make up only 19% of parents but account for half of all family breakdown.’ In other words, married couples tend to stay together more than couples who have chosen just to live together.

I will end with this quote:

‘Quite clearly getting married does make a difference to your life chances and your children’s outcomes.’ It has been shown to be socially advantageous. Married people are more likely to be happy than their co-habiting or single or divorced counterparts, despite the shocking divorce statistics. So let us look beyond those stats and go into marriage putting our best foot forward. Sure it is hard work but we all know that anything worth doing is worth doing well. So I remain a realistic optimist. I will work hard at my marriage and I will pray for my happily ever after. I think I deserve it.