Category Archives: heroism

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.

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What does a Junior Doctor Do Exactly?

A letter written to Jeremy Hunt by a consultant currently working in England.
An excellent illustration of how indispensible ‘junior’ doctors are to the NHS and the public as a whole. I couldn’t have put it better myself so I haven’t tried to 😀

…………………………..

Dear Mr Hunt,

My name is Philip, and I am a consultant physician. Not so long ago, I was a junior doctor and like many others I am outraged and angry about what you propose to do with ‪#‎juniordoctors‬ and their ‪#‎juniorcontracts‬.

I thought that maybe, given you have not worked in healthcare, you might not understand what it is that doctors do (much like if I was made, say, head of Network Rail) so I thought maybe I can help you by shining a light on what I used to a few years ago as a medical registrar.

The medical registrar is the most senior medical doctor in the hospital out of hours. In explaining to my friends what we do, I tell them everyone who doesn’t need an operation right away, or doesn’t have a baby falling out of them, above the age of 16, is our business (and often we have to look after those too). We were the ubiquitous shirehorses that carried the hospitals medical workload day and night. And here’s a typical night shift I did at a general hospital. (all details changed and adapted from real cases to protect patient confidentiality).

I arrive at 8:50 PM for a 9:00 PM handover. It’s been a busy day and the emergency department is full. The outgoing medical registrar tells me there are no beds in the hospital. There are 10 patients waiting in A&E for the medical team, and a lot of patients need reviewing on the wards. He’s already admitted 36 patients during the day, and the consultant is still there seeing some of them with the daytime doctors. I wave hello at her as I head into the fray. I know the consultant and she’s not seen her kids since her on call week started. She waves back wearily.

My first patient for review was a young man with abdominal pain. My first thought as I walked into his cubicle, he looks sick. This is a skill you develop after years of training, when you look at someone and know that they are minutes from death. He’s grey, clammy and shocked. I immediately set about treating his shock and assessing why this has happened. Does he have a bad infection? Is he bleeding? Does he have a blood clot on his lungs? A quick bedside test confirms he’s bleeding badly, likely internally, and my surgical colleague (another junior doctor) and I urgently arrange for an operation. He hurriedly talks to his parents and completes a inacapacitated patient consent form as his condition deteriorates. I leave him in theatres with the anesthetists and surgeons as I have other patients to see.

The next patient was an elderly woman who has fallen. Although she has no hip fracture, she’s unable to walk and needs admission for painkillers and rehabilitation. I reassure her as best I can and stop many of her medicines potentially making her fall. There are no beds for her on the assessment unit or the elderly care ward, so the A&E sister arranges for a pressure support mattress and bed for her in the department overnight. She was lonely and depressed, and I spend some time talking to her about her worries and fears but after a while I needed to move on. She squeezes my hand and smiles, thanks me and settles for the night.

Next is a resus patient with an asthma attack. He is drunk and abusive verbally, though he’s too breathless to be too abusive. A blood test show his attack is life threatening and he he fights off attempts to treat him by myself and the A&E team, pulling off his nebuliser mask and oxygen. As I read out the blood test result to the intensive care registrar (another junior doctor) the man goes blue in the face, gasps and stops breathing. I drop the phone, run over and take over his breathing with a manual ventilator. He has had a respiratory arrest. Alarms blare, help comes running, we inject him with various medicines to help relax his airways and the intensive care doctor slips a tube into his windpipe to help him breathe. The consultant physician, still there, helps with what she could, running blood tests and helping to scribe in the notes. After a nervous period, he stabilises and we take him to intensive care.

It’s now midnight.

In the meantime I have reviewed five more patients, seen by the twilight team, and also my night SHO has discussed some patients with me. The consultant finally got home around 11PM. I’m now on the wards, a liver patient with severe cirrhosis is unrousable. I read through the notes. He has cirrhosis and is not suitable for a transplant. The team has tried everything. I sit and talk with his family, telling them I’m very sorry but there’s nothing more to be done. They cry, one of them screams at me that I’ve killed him, but I accept this as part of my job. With more assurance they’re calmer and I reassure them he’ll be kept comfortable.

My bleep goes off as I write in the notes. Is that the medical reg? The hospital is now totally full, can you please choose some patients to send to our sister hospital down the road? I groan, although I understand the necessity patients understandably hate it. I pick four stable patients and liaise with the registrar down the road.

2AM. I send my SHO off for a quick break as I review some more patients. A confused elderly man who might have a urine infection, a young man with severe headache, a diabetic patient with a very high blood sugar, a lady withdrawing from alcohol and hallucinating. The A&E sister makes me a coffee, lots of milk, lots of sugar.

3AM. I’m with a man in resus again, he is vomiting bright red blood in large volumes. He is jaundiced and looks unwell, very unwell. As the A&E team arranges for a massive transfusion to be set up, I ring the intensive care doctors and the gastroenterology consultant. He listens and says “I’ll be coming in”. I then slip a line into his neck under local anaesthetic, a practiced skill that’s hard at 3AM when you’re tired, but fortunately successful. We pour blood, clotting products, medications and antibiotics into him to halt the bleeding. The gastro consultant arrives at 3:40 and he’s taken to theatres where he performs a life saving procedure. The patient goes to ITU.

4AM. A brief moment to sit down for a quick break. I have reviewed three more of the SHO’s patients. This is the first time we’ve had a chance to sit down together, a quick chat and a cup of tea was interrupted by a cardiac arrest bleep. We run to the cardiac ward. A 54 year old gentleman admitted with chest pain by the day team has had a sudden cardiac arrest. The excellent CCU nurses are doing CPR and attaching a monitor. I ask them to stop as it’s attached, the rhythm is ventricular fibrillation.

“Back on the chest please, charge defib to 150, charging. OK, off the chest, stand clear, top middle bottom myself, oxygen away, SHOCKING.” The patient jolts. “Back on the chest please.” I heard myself say.

Two minutes later he has a pulse. We repeat an ECG, he’s had a full heart attack. I call the cardiologist at the heart attack centre 10 miles away. He’s accepted and an ambulance crew transfers him for an emergency angioplasty. I send my SHO back to A&E as I write a transfer note.

5AM. The resus doors burst open. Another patient, an elderly woman with breathlessness. The A&E F2 listens to the chest, pulmonary oedema. She’s given the emergency treatment but it’s not working. I decide to start her on positive pressure oxygen. Strapped to her face was a tight mask blowing oxygen to inflate her lungs, buying time for the medicines to work. The plan works and pints of dilute urine fills her catheter bag, her breathing improves and she says thank you through the mask. Despite the fatigue I smile and give the F2 a fist bump for a job well done.

7AM. Four more reviews. a patient with kidney failure due to medications, a depressed young man who took an overdose, an elderly nursing home resident with pneumonia, and an elderly man with a broken hip whom I assess with the orthopaedic surgeon. I start to round up the patients for the ward round. 18 patients overnight, five transfers out, one death. A relatively quiet night. I check with the clinical site manager and SHO that we’ve not missed anyone and click save on the list. No one is waiting to be seen, a good feeling.

8AM. The consultant from last night arrives, she looks tired but asks us how we’re doing. OK we said. We start in A&E as most of our patients are still there, the site manager is worried as some of the patients from last night are coming up to 12 hours in A&E. We review each patient’s story and tests, and talk to them about their condition. We visit ITU for the two new transfers there.

11AM. The ward round of the night patients are done, and I have completed a death certificate for a patient overnight. I climb into my car and listen to the breakfast show as I drive home, an hour away. I’ll be in bed by 1PM , and back for the night shift after 6 hours sleep. A relative luxury from a relatively quiet night.

This would be a relatively quiet night for a junior doctor and I am sure many registrars would laugh at how easy I’ve had it! But the people doing this work are junior doctors, who show dedication, commitment and goodwill beyond belief. They do lifesaving work up and down the country, working hard without complaining and sacrificing time with their families.

Please, I beseech you, treat them fairly and with the compassion they treat others daily. The new contract is not fair, and the extended hours it’ll cause is not safe. ‪#‎notfairnotsafe‬

I hope this little story will give you some insight into the vital work junior doctors and the NHS do. If you like, please come and spend a night at our hospital, I’ll come in with you and show you around. Please talk to my junior colleagues and listen to them, you may be surprised what you’ll learn.

Best wishes,

Dr Philip Lee

My Very Own UN

My sister is (or should that be was) a social butterfly. She always had more than friends than she knew what to do with and she never had issues making new ones. A classic extrovert. I considered myself an introvert for most of my youth. Now with more self-awareness, I know I am more of an extrovert than an introvert but I am pickier than my sister, the true extrovert. Because I have been so picky, I think I have ended up with the best friends in the world.

Some of the people I am talking about might not realise how much I value their friendship or indeed that I am talking about them but I hope when I describe how fabulous they are, they will realise how great and valued their friendship is to me. When I was little and my mama was my only role model, one of the things I thought was absolutely amazing about her and her life was her array of friends. They were young and old, some local, many from far afield (and being in Yola that is quite something I tell you). Some Muslim, some Christians. Some skinny, some fat. Some beautiful, some not so beautiful. Some quiet, some loud. Many feminists like my mama. All sorts. The one unifying thing about them was that they were kind and caring, they spoke to me like I mattered and they were passionate. If she ever needed anything around the world, all she had to do was pick up the phone or send an email and the cavalry would arrive. Subconsciously, as I grew up, I think I looked for all those things in my would-be friends. I think I succeeded in developing my very own passionate, kind, caring, loving, helpful and loyal circle of friends. The inner circle is a small one compared to my mother’s but I happen to believe the best things come in small packages. I will talk about my current inner circle in no particular order as I value them all fairly equally. I won’t mention my mama and my sister but they are my best friends and are the core circle.

First one is my Ethiopian friend who I met in 2001 who I shall call Lizzie. We were in the same tutor group in Gladesmore Community School (10AH massive) and we both joined in year 10 so we had common group but our big unifier was where lived and that we had to get 2 buses to get to school. So, earlier than the other pupils, we were up and out, dragging sleepy bodies onto the 144 which I caught at the first stop in Muswell Hill and Lizzie would hop on 4 or 5 stops later in Hornsey. We were normally quiet in the 144 but by the time we got on the 41, we were awake enough to chat. It was on the 41 that I got to know Lizzie’s life story and about her very grown up relationships. At this stage, I had never had a proper boyfriend and despite having a crush at school, I wasn’t really interested in a relationship. So I lived vicariously through her. We also bonded over our love of heels (low enough to wear to school and get away from censure) and long braids. Also I have been mistaken for Ethiopian so we had a similar slim innocent look. We have remained friends over the years, closer after school than in school, through her babies and marriage, through my medical school. Lizzie was a bridesmaid at my wedding and she regularly makes the drive up to Birmingham from London to visit. Even though we had periods were we got too busy with our lives, she has remained a constant. We may drift (although not so much now) through complacency but we never fight and we are there to listen. So here is to my yummy mummy Landan friend. For being constant and loyal and inspiring me to be more glamorous and feminine.

Next is my Northern Nigerian friend who I shall call Halima. We met in 1996 in Queen’s College, Yaba Lagos and we were friends from the very beginning. It was the Hausa lessons that cemented the friendship and as we were both boarders, prep times and dinner times were there for us to foster the relationships. In another blog, I have mentioned Na’ima and I was close to a couple of other girls, 2 of whom were boarders. Halima was in a ‘House’ located all the way across the quadrangle which thinking about now wasn’t so far but during those years was enough to make visiting her during weekends a significant event. She was responsible for the one and only time I had periwinkles (the hairstyle) for Sports day in JSS2 (see blog on that). Those periwinkles make an appearance on my first ever British passport and my husband loves the photo so much he keeps it by his bedside. She was one of the only girls whose homes I would visit outside school too and I knew her family so that made her more special than many others. Post-QC, she is certainly the one who would always make an effort to come and see me whenever I went to Nigeria. I knew about her wedding as soon as she had a date in mind because she wanted me to be able to jiggle my doctor on-call to make it there.  I am so glad I did. We shared her pregnancy from across the distance too. In all these years, I do not remember ever fighting with Halima. She is probably one of the gentlest and sweetest women I know and her son and husband are so lucky she is theirs. Despite being many thousands of miles apart and despite our other friends from that era being on social media and living in close vicinity to her, Halima is the one of all that I would be able to count on today if I needed a friend in Abuja. What a sweetheart!

Then there is my Southern Nigerian friend, let’s call her Tolu. I met her through NLI which is a (NGO) Nigerian initiative to promote young accomplished Nigerians living at home and abroad to be the champions that make Nigeria great once again. NLI was in 2010, or was it 2009? I came from here and she came from the US. We bonded over our passionate pitches and speeches. Never before had I met a young woman who seemed so like me. She exuded integrity and honesty and passion. When I told my husband about her, the words I used were ‘Tolu motivates me to be a better person. I wish she lived nearby so I could be in her presence regularly’. Being next to her or chatting with her on the phone or on social media never fails to give me a positive boost. Tolu to me is everything a young Nigerian should be and she makes me so proud to be in the same circle as hers. If I could choose anyone for my baby to be like, it would be Tolu. She went through a very harrowing time a couple of years ago and being so positive and so strong, she didn’t say anything for a long time because she is that type of a person who will be everyone’s shoulder but have no shoulder to lean on herself. She has come through all of that in a way that is no less than heroic. She is generous and kind. She is a wonderful listener. She is passionate about life and justice and selfless in her outlook. Maybe I don’t want my baby girl to be like her, maybe I want to be like Tolu. Anyway, if you are reading this my love, I might not have said in so many words but your strength, honesty, passion and selflessness makes you wonder woman in my eyes and I could not be prouder of you. I hope your dreams for Nigeria and the world come through because this world is so much better for having you in it.

Following on neatly is my only fellow Iro-Nigerian, who I call Irish anyway. She is Irish in all the best ways possible except she lacks an accent being southern England-bred (sadly but she can put on a pretty good one). We went to medical school together and once again it was fate that brought us together because we met in student halls in 2004. Being the only two medics in the flat of 6, naturally we became close pretty quickly as we were together pretty much all day every day for the first 2 years of our medical school. We were up ridiculously early and gone all day. We couldn’t party any night of the week like a certain somebody we lived with. We had plenty of work and exams to keep us busy. The first thing about Irish is that she is a morning person. I am most definitely not. She would wake up at dawn even on weekends and whistle cheerfully. She had these dryer sheets that smelled of fresh laundry…even today, that lovely fresh scent equates to Irish to me. She has tremendous boobs (sorry Irish but I feel they need to be celebrated) and the loveliest bouncy hair which is NOT mousy brown as she used to claim. She is one of those friends I have never fallen out with. It’s strange to think but we don’t have fights at all. Perhaps it is because she doesn’t tend to get dragged into one of my deep philosophical conversations because she is quite squeamish with deep emotional stuff and would rather the happier topics. That is not to say that she won’t indulge me if I need to offload. She makes the best butter icing cupcakes and has managed to teach me to bake a couple of things. She loves sunflowers. That is in a nutshell Irish to me. She is little Ms Sunshine with a spine of steel underneath all the Gaelic charm. She will stand up for what she believes in and will call you out if you do something wrong but all with the sweetness of honey. She has dealt with family issues that would faze many but she remains unfazed and strong. She also has lovely blue eyes and dimples which I would give my little toes for. Oh and she gives the best hugs ever! If Tolu is the girl I want my daughter to grown up to be, Irish is the woman I want to be for my children. I want to be all sunshine and sweetness and quiet strength and I want to be charming just like her when I grow up.

Then there is my Indian friend who around birth was inadvertently called One on some documentation and that is my name for her which I shall stick to. She is the only one of my friends who is younger than I am. We met whilst I was out doing clinical experience in SEWA rural, Jhagadia – a village in Gujarat State, India. She was out there too doing field research and being the only other single girl resident in the flats on hospital grounds, we instantly gravitated to each other and became fast friends. She is a biomedical scientist. We quickly found common love in tea and laughter and feminism. We quickly fell into a routine. She would come over after ‘work’ to put her water in my fridge and we would go over to hers for tea. I would usually drape myself all over her bed and even occasionally on the cool floor for it was pregnant with heat during my 3 months there. My friendship with her is very similar to the one I have with Safa except the age difference and my having a bit more life experience. And our life stories seem to mirror each other down to meeting the ‘wrong’ boy as defined culturally but actually believing them to be our Mr Right. Unlike Safa though, she is the only one of my friends who is shorter than I am so I feel refreshing normal size next to her. One is rather fearless I think and having lived in remote Jhagadia for a whole year, she then applied for a post-graduate course in the US and off she went to live in NY. Now she is in Malawi, again independently sourced job and seems to be flourishing. What makes her so special goes beyond her fabulous tea, her wicked sense of humour and independent spirit. She is also very honest and open, kind and supportive, generous and when she loves, she gives it her all. One is going to be great someday soon. Mark my words!

Last but not least is my youngest adopted mama, Farah for today. I met her in 2009 as a lowly FY1 doctor in the crazy world of City Hospital (Birmingham). She was soon to be medical registrar and had a reputation for being brutally honest and fierce. Did that put me off? No! I love my women fierce and fearless so we became friends in the mess when I was on surgery and actually had time to go to the mess every day. I loved her unconventional ways and I think she liked me because though small and ‘quiet’ on the face of it, I gave as good as she gave and never seemed to take it personally when that sharp tongue was pointed my way. Despite the difference in years, in the hierarchical world of medicine, we remained friends over the years and have grown closer since we stopped working together. She is another one from a Muslim background who was born into the religion and though respects me for practicing, is not of the same opinions about it. I respect that despite being from a middle-eastern background, she is honest enough to say this is how ‘I’ feel about religion and all that comes with it. I love that despite that prickly first impression she gives out, she is a big old softie with a heart that is good as gold. She is loyal and supportive and she is always there for me if I need her. She wore a polka dot dress to my wedding – if for nothing else, I will love her forever. What a woman! Farah I salute you. You are one of my heroes.

There you are dear readers, my wonderful array of close companions without whom I would be less of the woman I am today. I will take this opportunity to say that for the reasons I have mentioned above and for many more that I cannot put into words, I feel privileged to have met and befriended you all. Thank you for all the love and support. I love you all.

Do Your Little Bit of Good

Desmond Tutu says: “Do your little bit of good where you are; it’s those little bits of good put together that overwhelm the world.”

What a great saying! I fully subscribe to it. I think the world would be in a much better place if everyone believed in doing their little bit of good and did it thus creating a lot of goodness. Most of the people I meet are very good people and have really good intentions but only a few are doing anything to put their good will into action to help change the world in their little way. I suppose I am actually privileged to work in healthcare though. Nurses and doctors do so much fund-raising for charity that we almost take it for granted. Most of my work mates will have badges, hoodies, t-shirts all bought for charity. Many of them are taking part in charity runs to raise money for great causes.

Many of our amazing little patients are also into their fundraising. You may have heard about Stephen Sutton who died from cancer a few months ago. He has just been awarded a Pride of Britain award post-humously. His story has inspired so many because instead of focusing on his bad prognosis (predicted bad outcome), he thought he would raise money to help find a cure for cancer for those who have the misfortune of following in his footsteps and to support those young people and babies with cancer. Even if he had raised only a £100, it would have been amazing because of the intention behind it. The intent was to improve the lives of others when it was too late for him. The intent was to make the world better for a group of unlucky people who have or will have cancer. Great news is that he has raised £5 million pounds so far and counting and his name has been immortalised for being so brave and selfless in his time of despair and illness, for making a difference. Stephen probably never dreamt how big his fundraising page was going to be but he did what he did anyway.

Malala who has just won a Nobel Peace Prize at 17 years old and is a fellow West-Midlander is another inspiring story. Her story started out small. I am sure she never thought she would end up living in the UK making speeches that are heard all over the world and getting complimented by the likes of Barack Obama and the Queen. All she did was speak out against the injustice of being denied an education because she and her friends were unfortunate enough to be born girls in Pakistan. She got shot for her pains but instead of being cowed by the real threat of the Taliban, she remains unrepentant and continues to be the voice for her fellow oppressed girls and young women. She has inspired thousands of girls in Pakistan and Afghanistan to insist on their right to be educated. A small thing that has metamorphosed into a huge thing for so many.

My mama has an NGO that works primarily to empower women and young people. Part of what they do is provide support in setting up small businesses and training in crafts. They also help find and pay lawyers for victims of domestic violence and rape. But their manifest is unlimited really. Whatever a child, adolescent or woman needs that they can help with, they do. They have helped end many forced child-marriages; they have helped girls/women get away from abusive relatives and start up a new life. They help women who are desperate to support their children train in simple skills that will help them earn a living so they know where their next meal is coming from and know that they do not have to go from door to door, asking for hand outs. They provide extra tuition for young people struggling with their education and their prospects of employment. They provide sanitation and educate on public health issues. They have even helped a young lady locate her birth father. The work they do is not exactly earth-shattering to read about and does not make the news but I know how much good they have done for the hundreds of people who have come to them for help. I know what a lifeline they have been and continue to be for so many. They are doing the little good they can do with limited resources but it is changing the world for those around them in Yola and beyond to the rest of Adamawa state.

All of these people inspire me so much and as a result, I have made a promise to myself. I might not be anybody. I am certainly not rich nor am I famous. I am not extraordinary in anyway but I have been blessed with an amazing family, a few great friends, a fantastic job and a life mate (my husband) whose love is so uplifting. I guess you could say that I am extraordinarily blessed. So I try every day to do or say something that will do some good for someone. The best thing is that my patients are great recipients of my efforts. So many children just want positive reinforcement to shape them into lovely responsible adults. So I find something beautiful about them and tell them about it. I tell them how gorgeous their curly hair is. How special their rare blood group is. How amazing their natural red hair is. How beautiful their glasses are. How brave they are. How happy their hard work to get better makes me. How brilliant they are to do schoolwork when their health is failing. I say good morning to the cleaners that keep our hospitals clean and I smile every time I pass them in the corridors because their job is hard and their pay is small but they are absolutely essential in helping us make our patients better. I buy badges, hoodies and t-shirts for charity and I wear them with pride.

So I challenge you my dear reader. If you ever watch TV or read about someone who has done something and you feel inspired, do a little something each day to brighten up someone’s day. It doesn’t have to be big. It doesn’t have to cost you a lot of money; it doesn’t have to be recognised by anyone. As long as when you go to bed, you remember the feeling of having done something good for someone with no strings attached and fall asleep with a happy heart. Let us all do the little things that are easy and free in life and hopefully the sum total makes the world that much better.

Being a Paediatrician

I knew I wanted to be a doctor when I was about 4 years old. I can’t explain now how I came to that conclusion or why I was so sure. I just knew and now I am a doctor. In my 2nd or 3rd year of medical school, as part of career guidance we were given a link to a website where we could input our data and get a psychometric analysis done on us. I had to answer a series of questions about how I felt about certain things, my beliefs, my principles, how I solved problems. Eventually, I answered the numerous questions and it took a minute or 2 to load. Then it gave me the list of medical specialities ranked according to the ones I am most suited. Pathology and neurophysiology came last as I would have expected but I was taken aback by the top 3 choices. It said: Paediatrics, Palliative Care and Neonatology. I poo-pooed the test and dismissed it. When I went into medical school, one thing I was certain of was that I loved children and I never wanted to see them sick and suffering. Therefore I sort of ruled out paediatrics very early on. Back then I thought I might end up being in Obs & Gynae (obstetrics and gynaecology) because it was a good mix of medicine and surgery and I thought the variety and acuteness would suit me. I also thought I could be a GP because it retained the versatility of all of medicine without having to make a choice.

During my Obs & Gynae posting as a medical student, I found that although it was interesting the speciality did not set my pulse a-racing. There was no eureka moment. The specialists were nice but I didn’t feel any kinship with them. My paediatrics was my last medical school posting and the moment I stepped into the Children’s Hospital (BCH), I felt an excitement. Even though most of it went over my head and there seemed to be a lot of calculations and there was the issue of small people who were not well, I felt right at home. Over the 6 week placement, I grew to love BCH. I loved the patients, the child-friendly wards with their play areas, the kindness of the nurses and most especially, here were doctors I wanted to be like. Who I enjoyed spending my time with. Who seemed to derive pleasure from their work even as they were rushed off their feet with the number of patients. By the end of that placement, the career puzzle for me was solved. I was going to be a paediatrician. And to my surprise, the patients I loved spending time the most with were the little premature babies born with complex problems needing surgery to survive.

As an FY1 (first year after graduation from medical school), I met a patient in her 30s who had inoperable incurable ovarian cancer. We bonded as I tried hard to get some blood out of her for some tests her consultant had ordered. When the ordeal was over, I thanked her for being patient and she called me back to say she thought I had a way about me that would be perfect for palliative care. She said she didn’t know if I already had my career mapped out but that I should think about going down the Palliative care route. I thanked her for her kind words and left in a reflective mood. Despite my psychometric prediction, I had never given it much thought. I considered it over the next few days and concluded that although I was a listener and when it came to my patients very patient (unlike in my personal life then), I wasn’t sure I could handle all the emotions that are linked with patients who are dying. So I filed the idea away under ‘unlikely’ and didn’t give it any more thought until just recently.

Earlier this year, I stumbled across an online course on paediatric palliative care and signed up to it. As I worked through the course modules, I realised that I was into all the issues that were being raised and although a lot of it was challenging, it was exactly the kind of challenge I relished. A lot of it was to do with talking about options and choices. About spirituality and counselling. About co-ordinating care. About letting the dying patient and their relatives dictate the terms about how these last days/weeks/months should be handled. I realised that palliative care is not just about the advanced care pathway which outlines what to do when death is imminent but also about actively keeping the patient well enough to reach certain goals. It is about enabling the patient to die in a way that is most acceptable to them. It is about being there for the patient and their family so that when things become scary or unexpected, there is a comforting presence to guide them through the darkest hours/days. So I have come full circle and now I know that I would like to sub-specialise in paediatric palliative care. I wish I knew where my Obs & Gynae patient was so I could share the news. I wonder if she is still alive today.

I love being a paediatrician by the way. If I don’t end up sub-specialising, I would happily be a general paediatrician. There is a different vibe on a paediatric ward or in a paediatric hospital like BCH. There is a friendliness that is missing in adult medicine. People seem to go out of their way more to be helpful in the paediatric world. Nurses do not seem to be as difficult or as disconnected as they can be in adult medicine. The paint on the walls is brighter happier colours. There are toys, music and games everywhere you go. The best bit about my job is the children. It is such a privilege to work with kids. They are amazing little packages, mostly untainted by the negativities that come with growing up. They come out with the best statements and questions that make you stop and think or laugh until your belly hurts. Their bravery is comparable to none and watching them as they struggle with illness and develop ways of coping is inspiring.

Of course paediatrics is a complex speciality by its very nature. Our patients are often too young to tell us how they feel and exactly what their symptoms are so we have to be more observant than our adult counterparts and we have to go on what other’s (parents/carers) impressions are more than the patient’s own words. Many do not understand why they feel poorly. They just know that they are not happy and they want it to be fixed. Parents are often not at their best when they meet us because they are anxious and stressed about their sick child and are frustrated because they have no solution to put them out of their misery. So yes, it is often the most difficult part of the job having to face irate upset parents who want to find someone to blame for their helplessness. Who want to take out their frustrations on someone else and make demands because it makes them feel they are doing something…anything. Sometimes, these parents do cross the line of anxious and stressed parents to parents who are abusive (mostly verbally but occasionally physically). Unfortunately, it comes with the job but we deal with it in our own way. Usually by being patient and reasoning with but where necessary we call on services to support and protect us. Luckily, these horrible encounters are not an everyday occurrence.

I have so many examples of the beautiful little people I have come across in my job but I will tell you about a recent one. I was on-call over a weekend and covering the haematology ward (haematology deals with diseases involving the blood cells). A 2½ year old boy with severe haemophilia B came in with bruising which meant he needed an injection of factor IX (the bit of blood he doesn’t make enough of which is essential to prevent you bleeding without much force). It was my job to treat him so with his parents and a fellow doctor assisting, we held him still and I injected the medicine into his vein. He cried as I did it and when it was done (it only took a minute), his parents prompted him to say thank you. Through his tears, he turned to me and said ‘thank you’. Then as I tidied up, they got their things together to leave and he waved and said to me ‘bye lady’. With no resentment. Despite the fact that I had just poked him with a needle for reasons he was too young to understand. I thought wow! Only a child would be as forgiving as that. The momentary feeling of guilt for making the gorgeous little boy cry passed with that exchange and off I went, to do more things to other children which might make them cry in the short term but looking at the bigger picture, everything I do is in their best interests so when I go home and I go to sleep, I feel happy and satisfied. And thankful for another day where I have done all I could to make another child’s life that bit better.

Here but for the Grace of God

lightI was 6 years old. It was the rainy season in Yola and the rains had come in and come in hard. In Yola, rain tended to fall predictably. Mostly heavy rain was late evening into the night and could last all night with thunder and lightning punctuating the pitch black night. There was always a power cut when those thunderstorms came but we didn’t mind because it cooled down so much that we reached for blankets and hot drinks. When it rained in the day, it was usually a slow build up. We all watched the pregnant clouds gathering. There would be no wind; the still before the storm. Then there would be a lovely light breeze which would quickly whip up steam and turn into strong winds. At this point, everyone would run out and grab all the clothes hanging out to dry, put away their food, crockery, shoes, livestock and whatever else was outdoors. All windows would be closed and latched. The humidity would build and everyone would sweat. Every bucket in the house was gathered, ready to be placed under the roof of the veranda after the first rain to catch some cold pure rainwater for drinking. Our dogs would sense the storm approaching and would go into barking fits. We would hear chicken flapping and squawking from the neighbours and children letting out excited shrieks.

Then as we all withdrew and watched from the window, the gusts would pick up the sands in little whirlwinds. The leaves would be shaken off the trees and the large Neem and Baobab tree branches would sway wildly in the wind. Then the huge drops of water would begin to fall and the children would dance around with their mouths open and pointing up to catch the first drops on their tongues before the downpour. Until the mothers noticed and pulled them back and latching the door shut too.

This particular morning, we woke up to the smell of rain. The sky was overcast but as yet there were no cloud to be seen. My sister, A’i (a cousin) and I decided to chance going to A’i’s father’s house. We thought it would be the usual slow build up and we would be back well before the action began. His house was a good 30 minutes away so off we went. As we walked, the clouds began to gather and by the time we got to his house, the sky was grey and the breeze was starting up. We stayed about 30 minutes then decided we couldn’t risk staying any longer because the downpour would start and we wouldn’t be able to get home for hours, maybe even all day and night or worse, we would get caught in it. They had no phone (not everyone had a landline those days) so we couldn’t call home to warn them where we were and that we would come back after the rain. As we didn’t want them to worry, we decided going back was the best option.

5 minutes into the journey, the whirlwinds started to pick up and we had sand in our eyes. Eyes streaming, we had a short debate about whether we should turn back. In our young minds, we would rather be home for the rain and not out visiting so we decided to continue with more haste. In another 5 minutes, the sky opened and torrents of rain lashed down on us. We were soaked instantly and getting colder by the minute. The roads immediately began to flood and soon we were wading through muddy water and getting slower as we went. Before long, there was so much rain that we could barely see each other or where to place our feet. Despite our best efforts to stay together, we kept getting separated as the elements pushed us around.

I was a tiny little thing, very lightweight so when I placed a wayward foot into the unseen ditch by the side of the road, I was immediately swept away by the current of muddy water. I spluttered and shivered and tried to find my feet but I couldn’t withstand the power of the water. Several times, I was tumbled by the water so I was immersed in it and swallowed disgusting mouthfuls. I remember thinking I was going to die and panicking. A’i was skinny like me so she couldn’t be of much help. All she could do was shout my name and I shouted back, only we could hardly hear or see each other. My sister was bigger, taller and stronger so somehow, she made her way to me and she eventually caught me several hundreds of meters down the road. She clutched me to her side and A’i drew closer to her other side. In this fashion, we dragged each other all the way home.

It must have taken nearly an hour to get home. I remember how numb I was all over. I couldn’t feel my hands and feet. I had painful goosebumps all over my skin. I was filthy. I was trembling like a leaf. I couldn’t speak for trembling. We were stripped off as soon as we collapsed into the house and put in the bath where warm water was poured over us until we regained some life. Then we were all wrapped up in large blankets and given hot sweet chocolate. As I sat there, still shivering and feeling like I would never again feel warm, I felt my eyes fill with tears and I thought ‘I am alive’. When my head was under water and I couldn’t see or breathe, I was certain I was a goner. My limbs were stiff with cold and fear and I would have surely drowned. Yet again, my sister was my hero! If she hadn’t been there…