Category Archives: death

We All Bleed Red

As I write, Minneapolis is on fire. Georgia is on fire. New York is on fire. I am in Birmingham, UK. Thousands of miles away. Yet I feel like my soul is on fire.

On May 25th, 2020, George Floyd, a 46-year-old African-American man was accused of writing a bad cheque at a store. Unarmed and unresisting, he was handcuffed on the ground. Officer Derek Chauvin, who we now know worked with George on security jobs in the last year, knelt on his neck. Despite George’s protests and pleas from onlookers saying clearly that he could not breathe, Derek knelt on his neck, compressing his windpipe until he fell unconscious. Floyd died. Derek was fired along with the 3 other officers who allowed this to happen. Nothing more was done until protests spread. Now Derek has been charged and is in custody. Only because the eyes of the world are watching.

Read this piece on Floyd, telling us how his family want us to remember him. https://edition.cnn.com/2020/05/27/us/george-floyd-trnd/index.html Let us remember him and let not his death become just another name on the long list of non-white Americans killed by the very people meant to serve and protect them.

Why do I care?

Because I am black. I have members of my family living in the US. All of them people of colour. Lots of different shades but none are pure white. All potential targets of all those who think white is supreme and that they have a war against us non-white folk.

More importantly, I care because racism and hatred transcend borders. It affects us all. The racists and those they are racist against. The anti-racists (I have just learnt this term). As a human being, I care deeply. As a mother, I care even more powerfully. That my beautiful daughter, with skin the colour of delicious smooth milk chocolate, is hated by some people. Just for being alive. That someone who does not know her might seek to do her harm. Scary thought. It makes me want to wrap her up and relocate to my dream Island paradise filled with only the people I love and trust.

Watch this little boy sing these heartfelt words. https://youtu.be/UIuSLBX74Ac What business does a 12-year-old have with such sorrow? Why must he beg to be allowed to live? We must remember that this is a boy living in America. Not Somalia, Russia, Colombia or Nigeria. America – One of the wealthiest nations in the world. Supposedly one of the most civilised and sophisticated in the world. Problem is that all I see coming out of America these days is tainted by racism. Amy Cooper last week. The almost weekly other white person using race to oppress ordinary black people going about minding their business. America, and indeed a huge swathe of the West, is showing its true colours more and more. There is hatred, racism, islamophobia, ignorance, white privilege.

But there is also love, solidarity, knowledge and people fighting for equality. I know it is there. And today, so many of those voices are speaking out publicly. Just go on any social media and white people are speaking out everywhere. Finally, it seems the tide of protest is loud enough maybe to inspire some change. The change that is needed is not small. The Police and the rest of Judiciary needs top down reconstruction. Institutional racism needs to be consigned to the bin. Discrimination needs to be stamped out. Until law enforcement and Justice is more equal across all people, there can be no real equality. We can and must be the generation that pushes for this to happen. We must keep our eyes open and keep calling out the injustice. We will not be silent any longer.

Finally, I want to leave you with Rihanna’s speech: https://youtu.be/fZiyZ2rDdv8

And the quote from the Right Honourable Edmund Burke (who died in 1797 by the way), an Irish MP:

‘The only necessary for the triumph of evil is for good [people] to do nothing’uk is not innocent

Abdul-Ra’ufu Mustapha: 24.07.1954 to 08.08.2017

This is easily the hardest thing I’ve ever written. I have been wanting to write it since I came out of the acute grief that I felt when he died. It’s hard to order my thoughts and feelings for my uncle Ra’ufu even today, 2 years and 7 months after he left us. His death has left a big hole in my life. Today, the grief is as fresh as on that sunny August day. Other days, I can rejoice in the good times we shared. First, I am grateful he died pre-Covid-19 because it would have destroyed me and his wife and kids not to be there with him in those last days. Thank God for small mercies.

I have decided a letter to him directly is the best way to do this. In between paragraphs, I will add names of songs that remind me of him or make me think of him now. He loved music so I am sure he would approve of the inclusion of music in my tribute to him. You’ll read it in the words below but I’ll say it now: I loved him so much and I miss him every day. He will live on forever in my heart and I am so thankful for the 16 years of consciously knowing and loving him. He was not perfect by any stretch of the imagination, but he was generous in all the ways it counted and he is one of the best men I have ever known. My father in all the ways it matters.

Dear Uncle Ra’ufu,

In 2000, I had a little brown address book. In it, I wrote the landline numbers, addresses and email addresses of the people in Nigeria that I didn’t want to forget after I emigrated to England. In it, I wrote in blue ink your name, phone number and address. My Mama said to call you if I was in trouble in England before she joined my sister and me. That was the beginning of my journey of knowing you. Of course, you knew me as a baby but for me, this was my first contact with you. I remember looking at your university of Oxford address and thinking ‘wow! He must be amazing to work at Oxford uni’. I had wanted to study medicine there, so it was like a fantasy institution for me. I didn’t need to call thankfully.
‘Light Up’ by Leona Lewis

We met in December 2000. Mama, Charo and I came on the Oxford Tube to Oxford and after a bit of confusion, on a cold dark December night, we found our way to Edmund Road. My memories of that night are a jumble. The sound system and shelves of music CDs, the Christmas tree, the smell of Nigerian food, the kids. Asma’u and Seyi – they were great kids. Despite the fact we had booted Asma’u out of her room (or was it both of them in that room?), they were both so warm and welcoming. As you and aunty Kate were. In the overcrowded living room, it was evident that this was a family where love resided. For the first time since moving to England, I felt relaxed and happy. My tummy was full of Nigerian food. I could be myself.
‘One Sweet Day’ by Mariah Carey and Boys 2 Men

So many memories but the singing stands out. You’d sing Barry White in your lovely baritone and the kids would groan and be embarrassed especially when we were out. You loved Robbie Williams ‘Rock DJ’ and every time it played on the radio (it was a big hit that year so they played it A LOT), you’d sing along. You pretended he wrote the song about a northern Nigerian woman called Dije (nickname for Dijatu, particularly in Fulani parts). The kids would argue until they were blue in the face that it was about a DJ. You stood your ground and I chuckled at the family drama.
‘Over the Rainbow’ by Israel Kamakawiwo’ole

Hand in hand with the singing was your cooking. Your cow leg pepper soup special was blow-your-head off hot with chilli, but I could never resist it. I also learnt your efficient way of chopping okro. You took me alone to a bookstore in an ancient Oxford building one day and bought me the hardcover of the complete Lord of the Rings book. It was mahoosive. I hadn’t ever heard of it and I wondered why you chose that book. I hefted it back to London with me and it was a transformative read. That was the first of many presents you generously bought me. I will treasure that book forever. And I will die a LOTR fan. What a book! You knew me so well even in those early days. Your house was full of books and my visits became defined by how many books I could read in my waking hours. I’d stay up all night finishing book after book. You and aunty Kate never got fed up of my laying about reading. I don’t think I helped around the house as I should have, so focused was I on devouring all those lovely books on your shelves and in piles all around the house. It’s not a surprise your home quickly became my 2nd home. How could I resist a home where music, books and good food were so central?
‘Hey There Delilah’ by Plain White T’s

Fast forward to 2013, I called and asked if I could bring George to meet you all. As always, there was no hesitation. He was my boyfriend, so he was welcome. You validated him. You and aunty Kate might have had reservations, but I was never made privy to them. We were in the kitchen alone one evening and you asked me if I was sure he was the man I wanted to marry. I said yes. You said ‘ok!’. That was it! Without you, I don’t know how we’d have organised the wedding. I asked you to be George’s representative when none of his family or friends would or could come to Nigeria to stand beside him. You organised the religious side of the wedding in Kaduna, bore all the costs without question. You even paid the sadaki on behalf of George. I wasn’t there so you organised for a photographer to record the day for me and delivered me a beautiful album. In March 2014, you were George’s father. You did a marvellous job and I know George will be forever thankful to have had you by his side during all that. Thank you.
‘Amazing Grace’ by Judy Collins

As if that wasn’t enough, I asked Asma’u if she wouldn’t mind if I borrowed her father to walk me down the aisle. She said yes without hesitation. She figured that you could practice being father of the bride on me before her wedding day. Little did we know that I would be the only bride you’d walk down the aisle. I asked you if you would walk me down the aisle. Yes, you said without hesitation. You asked me what to wear and I asked for traditional Nigerian. When I saw you outside my bridal room on my wedding day, preparing to walk me down the aisle, I felt so proud. You looked so wonderful in your green outfit. You said something calming to me (it’s all a blur now) and you walked me down the stairs and then down the aisle. One of my best memories of the wedding was when you and aunty Kate broke into traditional Yoruba dance. I was so happy in that moment and so proud to have you all by my side as I started my new chapter.
‘With You’ from Ghost the Musical

Every Christmas or NYE I could, I spent in Oxford with you. You taught me about music, about politics and religion, about caring for the world around us and giving back. The trips to Bicester shopping village on Boxing day was a tradition I loved. Even if I didn’t have much money to spend and I wasn’t a big fan of shopping anyway, I loved it because we spent that day together. Getting out of the house was always a mission. We were never out at the planned hour. We’d then struggle to find parking but we would find a spot eventually. We always had to stop in the Bose shop and listen to their demo. We always stopped at Eat for lunch. We’d finally traipse back to the car laden with shopping bags, exhausted. Then spend the 27th recovering from our exertions. When I started working for the NHS, these traditions were invariably interrupted and I only partook in them partially. It was the only reason I minded working over Christmas to be honest.
‘Happy’ by Pharrell

In June 2014, I remember jumping into my car and driving down to Oxford to escape the house where my in-laws were staying after the biggest fight I’d ever had with George. I was so upset. I sat at the table with you and aunty Kate trying to hold back tears. I didn’t want to share it all with you to be honest. I was always mindful of the advice not to share your husband’s worst faults with parents because they won’t forget long after you’ve forgotten. I remember you seeing my red eyes and you looked angry. Angrier than I’ve ever seen you look. You clenched your jaw and you hurriedly walked away from the table. Aunty Kate and I talked for hours. She cried with me and consoled me. You came down when she had worked her magic and I was calm again. When I left the next day, you hugged me tighter than you had ever done. It helped.
‘Umbrella’ by Rihanna

In November 2016, I came for a visit a day after my birthday. I had spent most of my birthday alone. George had gone to Abu Dhabi for the formula One. I was left with my Velcro baby, exhausted beyond belief. Tete (Lorraine) and Kudzi took her off me for 3 whole hours whilst I treated myself to a child-free meal and a whole-body massage. I came back feeling better than I had since giving birth and they surprised me with a birthday meal. It was lovely. But the next day, I wanted to be with my family so I got on the train and came to Oxford (Savannah hated being in the car so it didn’t occur to me to drive down). You were at the station to pick me up. Savannah must have had the sense that you were my people because she went to you and aunty Kate and let me rest my aching arms. I had tummy issues so couldn’t have your cow leg pepper soup. I remember your crestfallen expression when for the first time ever I turned down your offer to make pepper soup. It turns out that was the last time you’d offer it to me. I haven’t eaten it since.
‘All of Me’ by John Legend

My tummy issue turned out to be a treatable condition called microcolitis which when it was finally diagnosed was treated. I didn’t admit to you and aunty Kate that I was worried I had cancer. I had lost more than 10% of my body weight in the 6 weeks since onset of symptoms, I was exhausted and felt very unwell. I was worried about dying and leaving my infant without a mother. When aunty Kate called me 3 weeks later to discuss her concerns about your reflux, cancer was already on my mind. I remember telling myself not to be stupid even as a corner of my mind became anxious. Aunty Kate called back the next week to say you’d gone to your GP and were on anti-reflux medications only but your symptoms were worse. I remember talking to you then, urging to go back. You were reluctant as it was over Christmas with reduced GP hours. I had a bad feeling in my gut, it didn’t go away. Still there a bit now. You went back and they put you on the 2-week wait pathway, confirming my fears of cancer were reasonable. I had a heart to heart with aunty Kate and admitted to her that although other things were possible, cancer was the most likely and for her to prepare you for that possibility. Now looking back, I wonder how she bore it. She was so calm in the face of the turmoil she must have felt internally. I remember coming off the phone after one of those talks and crying. I knew then that you had cancer.
‘You Make Me Wanna’ by Usher

It was confirmed on histology weeks later but the appearance of the ulcer and description was quite conclusive and I told you both. I was devastated. I hadn’t been able to see you during this time between working and trying to get some rest with the Velcro baby. I regret not coming down anyway. I should have been there in person. For you and aunty Kate. I should have come with you to the appointments to ask all the questions I felt weren’t being answered. Relaying my questions via aunty Kate felt inadequate and cruel to be honest. I was working hard to keep your hope alive whilst I was losing all hope myself with my medical hat on. I had seen this story play out with my patients. Little did I expect to be on the other side, living the nightmare.
‘We Are Here’ by Alicia Keys

Eventually, we realised that the cancer had spread more than we first knew so it wasn’t a curable cancer. We started looking into trials for you. Things didn’t go so well clinically and chemo was recommended by your oncology team to slow down the progression. Once chemo started, you went downhill. I think I was afraid to see you in person so I put off seeing you for months. I saw you in February 2017 and the change in the 3 months was shocking. Aunty Kate had been kind in her descriptions of you. You were clearly gravely ill. The chemo rendered you ineligible for trials. Aunty Kate and I talked about trials in India but by April-May, it was clear you were too weak from the chemo. I cried and raged when I was alone. One day, it was just me and you sitting down on the dinning table and you apologised to me about not making my biological father step up and be a father to Charo and I. I was so sad at your words. I remember saying you had nothing to apologise for. He is an adult and it was his failing and not yours. You insisted that you could and should have done more. I was angry that you were taking on his failing as a father. I remember lying in bed that night angrily wishing that it was him with the cancer and not you. It is not a charitable thought I know but I still feel that in moments of anger that I feel for losing you.
‘Castles’ by Freya Ridings

At this point, you were in and out of hospital as your vomiting and poor oral intake was becoming an issue. I was at a loss for words to make it bearable so I took to sending you videos, jokes and photos of Savannah. You always replied and that reassured me that even if physically things were bad, mentally you were with us. On another visit, I sat with you and you admitted the worst thing about the chemo was your mouth soreness and how dry and tender your hands were. Asma’u gave me some Vaseline intensive lotion and you let me massage that into your hands. You smiled at me and it felt good to give you some comfort, even if temporary. In May or June, you called me out of the blue and in your weakened voice, you asked me directly if it was time to get your affairs in order. It was the first time you and I had talked about your death. I remember closing my eyes as my heart broke once more. After the longest pause, I said yes.
‘ABC’ by the Jackson 5

You stopped replying to my phone messages shortly after this conversation and couldn’t speak on the phone so most of our communication was through aunty Kate between visits. She and Asma’u told me about how hard it was for them to watch you not eating. They told me how grumpy you were about taking the medications. In July, with the agreement of the oncology team, most of your medicines were stopped and palliative care started in earnest. You enjoyed lying on the lounger in the garden, soaking in the sun. You were cold despite the heat of the summer sun. You barely spoke. Your words were few and far between. The most alive part of you were your eyes. Sunken into your face. I couldn’t look at you mostly because when I did, I had to face the reality of your impending death. Still I remained fully at work. I should have taken time off at the end of July. Why didn’t I come for your birthday? Even if it was a full house? I could have driven down for the day. I knew it would be your last with us. I didn’t come then. The next week, I woke up one morning and the feeling in my gut was stronger than ever. I called George to ask him to pick Savannah up from nursery. That I needed to see you that day. I spent the day with you and I knew your days were numbered. I tried to warn aunty Kate. I think she knew anyway. I sent George down to see you that weekend and say his goodbyes. I didn’t want him not to have the chance.
‘Alive’ by Sia

On the 7th of August, I came down again, without Savannah as I wanted my focus to be you and you alone. You were bedbound by then. I sat downstairs chatting with aunty Kate and Asma’u about the funeral and where you were to be buried and how to navigate the conversations with your family in a culturally sensitive way. We all knew that the end was nigh. Seyi left us to it. I guess he wasn’t ready to talk about it. Selfishly, I argued for you to be buried in Oxford so I could keep you close. I had to concede your preference was probably Ilorin even if you left the final decision to aunty Kate. Aunty Kate was due at the Nigerian High Commission the next day to apply for her emergency visa so she could come with you on your final journey home. I went up finally, alone, to sit with you. That morning, my intention was to thank you for being my father and to reiterate that you weren’t to carry the guilt of my father’s failings. I even practised what I would say to you on the drive down. When I sat next to you, you roused yourself to answer my formal greetings in Hausa. You were breathless and so weak. I couldn’t say my practised words to you as it would mean admitting to you and me that I was saying goodbye. Instead, I held your thin hand in mine and told you about Savannah. When you started to drift off to sleep, I whispered thank you and I love you. I stood in the doorway composing myself and watching you snooze.
‘Perfect’ by Ed Sheeran and Beyonce

I planned to be back on Thursday with Savannah. As I left the house, I didn’t think that would be the last time I saw you or touched you or spoke to you. The next day, I got a message from Idris asking me to confirm the news. It was then I realised you had left us. I text aunty Kate: ‘is it true?’. She text back ‘yes’. You had left us. The rest as they say was history. I came on Thursday with George. We helped aunty Kate prepare to take you home. We talked. We cried. We listened to Josh Groban’s Take me home as per aunty Kate’s request before they got in the car without me and accompanied you on your final journey. I was on-call that weekend and the NHS doesn’t give leave for non-immediate family member. Aunty Kate hugged me tight before she got in the car and said, ‘I will look after your father for you’. I should have told the NHS that you were my father. I didn’t. I should have gone to Ilorin with you. I will regret that forever.
‘Survivor’ by Destiny’s Child

I hope you knew how much you meant to me. How much I love you. How much I valued your love and all the time you spent with me. I hope you know how much you have helped shape me. How I am planning my hospital because you inspired me with the philanthropic work you did. I don’t know if a part of you is here. I hope it is. I feel you here. Whenever I see okro or cow leg, whenever I hear a deep belly laugh like yours or hear someone speak with your accent. I feel you whenever I see the Bose logo, when I hear 70s and 80s music you introduced me to. You will be part of me forever. You will never die fully as I hold a piece of you in me and it will live on as long as I live. When I show her a photo of you (which I do often), I asked Savannah ‘who is that?’. She always answers ‘Uncle Ra’ufu, your father’. Right out of the mouth of my baby. Rest well my father.
‘Missing you’ by Puff Daddy

Your daughter.

Covid-19: The Fallen NHS Heroes

You may have seen on the news that the first 4 doctors to die on the NHS frontline are all male, African and 3 out of 4 of Arabic (Sudanese) origin. We, in the medical family, have understandably been analysing this news with super-critical microscopic gazes. I will take you through the most prevalent theories and one of my own at the end.

  1. Genes: maybe something in the African DNA makes the coronavirus more dangerous to us. In the early days of Covid-19, there were a lot of false theories about the virus not liking the heat and that this was why it didn’t strike in Africa for so long and is still relatively contained. Possible I guess but as it is an RNA virus and viruses like to attack DNA, it is more likely that it’s more to do with DNA than environmental factors such as temperature and weather. Perhaps we have particular DNA sequences unique to Africans of that region (Sudan and northern Nigeria) that means the virus is more likely to successfully infiltrate our cells to replicate and overwhelm our defences. Maybe Africans are not getting infected as often as non-Africans but those that do, get a more severe disease?

Advice: don’t be foolhardy fellow Africans. As we can’t alter our DNA (yet), we need to follow the shielding/self-isolating/hand washing rules very strictly. No visiting family guys. This is serious now.

  1. Vitamin D deficiency: it is a known fact that in the UK, a large proportion of non-white people have either insufficient or deficient vitamin D levels. Many of us don’t know this unless we go to our doctor with generalised symptoms such as tiredness or non-specific widespread aches and pains and we have a blood test. Or if you’re a woman when you see someone for pregnancy or menopause related appointments. When I was in medical school, the importance of vitamin D was just starting to emerge outside of bone health. I remember an Ophthalmology consultant telling me to look up vitamin D in cancer and that if I was to learn anything from him, it was that I should take vitamin D supplements every winter for the rest of my life. Anyway, it turns out that vitamin D is central to many of our metabolic processes – in other words all those things your body is doing at cell level to keep you alive and functioning. It has something to do with Cancer, all autoimmune diseases, brain function, eye disease, mental health. You name it, vitamin D probably has a role. Therefore, it is a solid theory that these 4 doctors could have had that in common.

Advice: probably worth being on vitamin D if you live anywhere like the UK where the sun don’t shine most of the days. Or relocate back to the Homeland (lol)

  1. ACE inhibitors: there has been a link proposed that people being on these anti-hypertensive (BP) drugs having worse outcomes from Covid-19. In simple terms, those on these drugs (common ones Elanapril, Ramipril, Captopril) are more likely to die if they get sick from coronavirus. African have the highest incidence of hypertension in the UK so it makes sense that these 4 men might all be on an ACE inhibitor.

Advice: do not stop your anti-hypertensives without seeking advice from your GP. Even if this theory proves right, if you practice shielding/self-isolation and good regular handwashing, your relative risks will remain very low. You are at risk of complications of high BP too (heart attacks and strokes) and it is a balancing act.

  1. Inadequate PPE: this is likely to be a huge contributing factor. I think this is most likely the issue. Despite Bojo and his Government officials making grand announcements about PPE availability for NHS staff, it is not so in reality. Doctors across England are reporting a lack of PPE and feeling forced to see patients regardless. As a group, medics are prone to putting themselves second to the needs of patients and whilst that is admirable, it is also unwise. Up to 25% of healthcare workers will be infected with Covid-19 according to statisticians. This number should be much less. Of those 25% it is estimated looking at global data (particularly China, Italy and Spain) that between 5 and 10% will die. Maybe more as data is incomplete. If you look at the number of NHS staff, those numbers are huge! We medics are not indispensable. We are a limited resource and no, despite Jeremy Hunt’s claims of yesteryears, no one can magic up 1000s of doctors in the next few months. Not even if you paid them double of what you’re paying them (remember the junior doctor contract bullshit everyone?). No amount of money is worth dying for. Especially if you’re a locum and your family don’t even get a death in service pay out to compensate them in a little way for your loss.

Advice: if you are a healthcare worker, do not go within 2m of a probable Covid patient without an FFP3 mask and full gown as per WHO guidance. Help them from a distance if you must. If you are put under pressure to go closer, walk out. What are they going to do? Fire us all? A sick or dead doctor won’t do the patients any good. Trust me.

  1. African Bravery: I really don’t mean this to sound like I am victim blaming or being flippant, but this is my take on it. These 4 men probably had risk factors that meant they should not be frontline. Be it due to age or comorbidities (existing illnesses as per Government guidelines like Asthma/COPD, chronic heart disease, autoimmune disease, on cancer treatment). But they decided to be brave and put the need of their patients first. If they are like the African men I know (I come from Northern Nigeria like Dr Alfa Saadu), they would have prayed (all Muslim too) for protection and gone to serve with inadequate, despite knowing the risks. Whilst I admire that bravery, I really do think it needs to be discouraged at times like these. We cannot afford to lose medics who are essential in combating this pandemic. We need the Government to step up to the plate and provide correct PPE for all frontline staff. All of them. The Government/NHS says full PPE only for those performing aerosol generating procedures. I put it to you all that one of the commonest symptoms of Covid-19 is a cough. That is an aerosol generating procedure. As you cannot predict when a patient will cough, you should always be in full PPE. Simples. Only patients who are ventilated are not at risk of coughing on you if you go in close.

Advice: don’t be a martyr. You are more useful to the NHS alive and well. Demand full PPE or work from a safe distance from all possible cases of COvid-19. Walk away if you must. Go and work at another hospital that will provide you with the right PPE.I quit the NHS and clinical medicine 2 years ago in March 2018. I had many reasons but basically, although I loved my paediatric patients and a lot of my peers and the paediatric nurses, I felt that the NHS was a poor employer and didn’t care about the individual. I couldn’t see me working for 30 years as a consultant in the NHS. Couple that with Jeremy Cunt and the junior doctor contract debacle which forced me to see that the public we serve generally has no appreciation for the sacrifices we make as doctors in the NHS and think that it has to do with pay. My health and wellbeing was beginning to suffer and I had a baby to put first. So, I quit and moved onto a non-clinical medical role. I took a pay cut to do it (it really isn’t about the money folks) and lost the security of my NHS pension and sick pay. Despite all that, in my new job, I am treated with respect and feel appreciated. My mental health is much better. I am in a better place career-wiseThen bam! Covid-19. I am one of those doctors whose licences have been restored by the GMC. I have agreed to return to serve the NHS through this time. In February, I was very ill. With hindsight, I think I have had and recovered from Covid-19 (which would be great as that’ll mean I am immune going back into the viral soup that is the NHS). But my recent illness and exacerbation of asthma puts me in the higher risk group. I am also an African Muslim which is beginning to look like a risk factor. I am on vitamin D supplements and not on ACEi.Whilst I am happy to sacrifice and serve, I will not be going to the frontline without adequate PPE. I intend to stay safe and alive. My daughter will have her mother for many years to come if it is in my power to insure that. That is my promise to myself and my worried friends and family. I aint going nowhere without a fight!Stay safe folks. Peace and love

Physician Heal Thyself

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

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

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

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

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

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

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

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

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

 

The 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.

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 Cycle of Life Part 1

As I said in the bit about me, I am a realist with a healthy dose of optimism. Apologies that I am again going to write about death. It may seem morbid to my blog followers but I do not always find talking about death negative. I dwell so much on it because it is my way of not forgetting those who have left footprints in my heart. Also because unfortunately, for someone who has been fortunate not to be from areas where death is a daily occurrence, I have seen more than my fair share. In the old and in the young. If you are squeamish, this may not be the blog for you.

I write this in the living room of my sister’s flat in Abuja and this was prompted by another blog I just read and also by a conversation I had with my sister. It was a long conversation but it ultimately lead us to discuss our mortality and how death can strike unexpectedly, about being a parent and planning for that eventuality to ensure your children are taken of and about writing wills etcetera. Despite the gravity of the conversation, it was quite an uplifting one. The words to follow are snippets of memories centred mainly around 3 deaths that have literally changed my life. These are young people who no one expected to die and their manner of death changed the way I think about death.

The first was of a classmate from Queen’s College, Lagos. It happened in 1999. She (I will call her Eve here) was not a girl I was particularly close to or even fond of. But I had known her for nearly 3 years when tragedy befell her. Eve was the daughter of a quiet unassuming teacher who I will call Mr Brown here. Mr Brown was the complete opposite of his daughter. Where he was quiet, she was loud. Where he was always serious, she was always laughing, finding the humour in things even when it wasn’t appropriate. She was tall for a 12-13 year old and he was a short man. She was fair where he was dark skinned. The comparisons were striking being that they were father and child. Anyway, Eve was the class joker. She was always loudly laughing or telling a joke. She was always planning the next prank or calling out funny witticisms from the back of the class. Sometimes, it was distracting so I wasn’t always laughing with her but I never thought her to be malicious.

We came back for the 3rd trimester of JSS3 and Eve didn’t. Soon rumours began to circulate about her being unwell. Then we heard that she was in fact really quite sick and was admitted in hospital. Then we heard that she had been victim of an acid burn. The extent was unclear but we did not expect how grave it was. Why we asked? And we kept asking. She was only a young girl. Why would anyone do this to her? I was pretty sheltered so I had never heard of acid attacks nor did I know the usual motives behind them. My more streetwise classmates told me that normally jilted or scorned (adult) men were the perpetrators were and the victims the poor unfortunate girls/women of their affections. It was mainly a Southern thing back then so I had never come across this despite my mother’s job.

This was the perplexing issue to us, her classmates. Why would a girl so young attract such affection? Soon, we again heard that the attack was aimed at her older sister (also in our school but nearer 16 or maybe 17 year old). We were told that Eve opened the door to their home unsuspectingly and she had acid thrown in her face. We were told that she was badly burnt and had been admitted to the hospital weeks before we were hearing of it and was in a serious condition. We talked about her non-stop for a week. There was a sombre mood in the class. It was as if no one felt right to take over her role. So there was no joking or pranking in those days. We all feared the worst as the news we heard was comprised solely of rumours. Like Chinese whispers, we were unsure who to believe.

One morning, the Day students (as opposed to us Boarders) came in talking about the 9 o’clock news on NTA (Nigerian Television Authority channel, national news broadcast). Eve had been mentioned as there was an appeal for funds. The attack on her and the resulting serious injuries were so serious that the doctors in Lagos could do no more and I think the thrust of the news was that her family was appealing for donations to take her abroad. This was when we realised just how bad things were. We sat around in silence, praying for some news. Mr Brown turned up in our class that morning. For once, no one needed to ask for silence. We all sat in our seats and looked at him expectantly. He spoke to us in his quiet voice. His eyes were red…from exhaustion or from tears – it was hard to tell which. He confirmed the rumours. Eve had been the unintended victim of an acid attack. She had been home alone when the men called and as she was so sick, she could not identify her attackers. She was in hospital in a stable but critical condition. He left. For the next few weeks, we continued to whisper about Eve. What did critical mean exactly? More rumours about who the intended victim was and the suspected attackers. About the extent of her injuries. Some adults had been to visit and they all agreed it didn’t look good. Despite all our fears, she remained alive but in a ‘stable condition’.

End of term for us JSS3 students came early and on our last day, some kind soul had organised a bus for those of us who felt up to visiting to go and see Eve. Most of the Northern girls declined to come. I was the only Northerner to get on the bus. In total, out of 90+ classmates, the bus held less than a dozen of us plus a couple of adults. The bus ride was made in total silence. You could smell our fear and the tension was palpable. I mouthed prayers, praying that I could handle whatever condition she was in. I don’t remember much of the usual Friday traffic and the heat. I remember walking off the bus in a single file and how much I was dreading what I was about to see. The smell hit me first and I felt my gut roll. My nostrils curled inwards, as if to block off my nose and the smell with it. I thought I would faint. It was the smell of decaying human flesh reaching the corridor outside her room. I could hear someone whimper and start to sob within our group. We all marched on following the adult leading us in. We stopped by the door as she announced our entrance. When she opened the door, the smell hit us harder followed closely by the sound of Eve taking breath after painful breath. My knees locked and a part of me wanted to bolt. I remember telling myself sternly that I could face anything. If she had to be here, I could visit her. Even if only for a minute.

On wobbly legs, I followed. I inhaled and held my breath. The bedside cabinet was groaning under the weight of medication. Mostly topical and oral stuff with cotton wool and forceps in a metal tray. She was barely visible. Her head was uncovered and there was a lady (her mother?) whispering in her ear. Asking her to be brave, not to scream in pain as she had begun to do. ‘Your classmates have come to visit’ the lady whispered into the hole where her outer air should have been. She seemed to hear her and she lapsed into her painful breathing again. The rest of her body was covered. It was beneath a metal cage over which a sheet was draped. I could not see underneath but I was certain she had burns all over her body, which was why she was lying so. To prevent clothing coming in contact with her skin. We all took turns to step up next to her and tell her who we were. Her eyes were covered, she clearly could not see. The hair on her head was badly singed and what was left of it was in a clump, stuck to her skull. All of her skin was badly damaged. You could see bits of colour imbedded in the skin of her face and neck, clothes melted into her skin. Her nose was gone…there were holes for breathing but no nostrils. Her ears like I already mentioned were missing too. All that was left were holes leading to her middle ears. Her lips were also damaged and her mouth was hanging upon as she struggled to get air in. Through her open mouth, you could see her blackened shrivelled tongue.

She grunted when each girl said her name. We retreated to the back of the room and stood silently for some time. Her carer took a bottle from the cabinet and dropped it onto some part of her face when she started to complain of pain again. Soon, her bravery was unable to contain her pain any longer and she began to whimper. This very quickly turned into screams of anguish. She was clearly in unbearable pain. We all had tears in our eyes as we were ushered out. Her carer came to us and said ‘thank you so much for coming. I know Eve appreciates it’. None of us replied, we were too busy crying. We got back on the bus and gave way to emotion. I remember staring unseeingly out of my window as tears coursed down my cheeks. I wept for nearly an hour, until we got back to school. When I got off the bus, my face was dry. It was obvious I had been crying but the tears stopped. I had to be brave. I got my things and I went home. I did not speak much of it over the next few days except my family would ask how I was doing whenever the appeal for help with medical costs was broadcast. Her death was announced on the Tuesday after we visited. Although I didn’t say it out, I sent a word of thanks to God for answering my prayer. My prayers on the bus after we left was that He put her out of her misery. I was sad but life went on.

About a month later, 2 of my older male cousins, my foster sister, my sister and I had one of our late nights of playing cards by the light of a lantern on the veranda whilst most of Yola slept. It was around midnight and Yola was definitely in bed by then. We were suddenly famished and we rooted around in the kitchen to no avail. We decided to go out and buy some food. We walked in the quiet to the night market (‘kasuwan dare’), fearless in those days of anything untoward happening. Yola was that kind of town. Despite the fact that 3 of us were young girls, we felt safe enough in the company of 2 older boys. We bought food and came home, had a merry little feast and were in the middle of telling jokes and laughing when it suddenly dawned on me that Eve was dead. Just like that. She would have no more holidays, no more jokes, no more laughs. She was gone. Forever. The enormity of it hit me. The pain she was in, the senselessness of her death (her murder come to think of it) and the grief her family must be going through. How had she felt just before the attack happened and when she had the acid thrown at her? How had she borne the pain for so long? Could she smell her own flesh decaying? Did she realise how badly she had been hurt? Did she know she was dying?

From laughter, I dissolved into tears and I could not stop. The more I thought about her, the more I wept. The others were concerned. I told them through my tears not to worry. I was just remembering Eve. They were worried I could see but also understanding. This carried on for maybe half an hour. Eventually, my sister suggested that the boys go home. My sisters would look after me. I smiled through my hysteria and tried desperately to compose myself. I remember rocking as I sat on the ground, hugging my knees and trying not to hyperventilate. I was sobbing out loud, my eyes closed as I got flashbacks of Eve in her eventual death bed.

My sisters asked what the matter was when I did not show signs of stopping. I said ‘I will be fine. I don’t know why I can’t stop crying.’ Actually I did know. I could not stop imagining myself as her. Going through that ordeal, surviving for over 3 months with all the pain. Unable to talk, unable to move, unable to ask why. I thought mostly of her mother, who had to watch her daughter go through this. I thought about the inadequacy of treatment, how she was clearly in pain but there were no painkillers strong enough to control her pain. I thought of her sister, who was rumoured to be the intended victim. How did she feel? Did she feel bad her little sister had taken her place? Did she feel guilty by association? I thought of Mr Brown and his wife. I knew they would be devastated. I had seen it in their eyes. How were they carrying on? How could they bear the pain? If the pain I was feeling was so deep and I wasn’t even that close to her, how must they feel? How could they bear to be alive?

It took over an hour for me to calm down and stop the sobbing. I still cried. Until dawn that day but silently as my sisters lay next to me and went to sleep. I got it all out then and not once since have I shed a tear over Eve but I remember her whenever I think about life and death. The details are unclear to me now but I think her attackers were caught. Her sister was a witness in the case. I don’t know if they were convicted and what happened to them afterwards. We never got to go to the funeral because it happened over the summer holidays.

Life moved on when we returned to SS1. Without Eve. She had never made it out of her pinafore and into the skirt we were now wearing as senior students. Whenever someone said someone funny, we would refer back to what Eve would say. Mr Brown, bless him, looked devastated whenever we saw him, which wasn’t often. He did come to say thank you to all of us for our prayers and our parents’ donations. He especially wanted to say thank you to those of us who visited. He said we helped Eve. I hoped so. As the days turned into weeks and weeks into months, we gradually moved onto other topics. Other girls soon took up the mantle of class clown and the laughter returned. Still, I never forgot and I know at least within my circle of friends at least, none of us will forget her. She lives on in our hearts. What a senseless loss!

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.