Thursday, August 03, 2006

Once upon a time in Nigeria...

Fever, nausea, vomiting, diarrhea, shaking, chills, sweating...

It’s a bit embarrassing to leave a blood donor clinic after meeting with the nurse, without giving blood. I assume that people are thinking about me, “Why can’t he give blood? Does he have AIDS? Did he say ‘yes’ to the screening question, ‘I had sex with a man for money or drugs since 1979?’”

I’ve had to leave without donating twice, for none of those reasons, and both were only temporary deferrals. The first time was because I had been to Turkey, which is a malaria-risk country, and yesterday was because I had just gotten my measles/mumps/rubella vaccine updated last week. Should’ve looked up the guidelines before I went.

The funniest part about me not being allowed to give blood after going to a malaria-risk country is that every time I give blood, I already tell them that I have had malaria...possibly.

Back when I was a first-year pre-med, I had the chance to chat with the dean of a med school, since he used to be a neighbour of ours. He told me something that ended up changing my life. “If you want to apply for medicine, you should spend time finding out what it’s like. Talk to doctors. Read books about medicine, such as William Osler or Hardy Cushing’s biography. And get experience doing it – the best way to do this is to go to a third world country and work with a doctor.”

I had never pictured myself somewhere in the slums of an African city giving out medications to lepers, but because of that conversation, that’s where I found myself a year and a half later. Going to Evangel Hospital in Jos, Nigeria (link flickr) was an incredible, life-changing experience. I was able to see and do so much.

One of the themes I picked up on was that people would generally wait for a while to go to the hospital, for a variety of reasons; they were scared or didn’t trust the white man’s medicine, lack of financial means, or transportation issues such as living in the bush. Because of this, I watched a woman with a softball-sized goiter removed, a man with a football-sized tumour on his arm removed (it had grown back after being removed 5 years earlier), a 9-year-old girl with osteomyelitis that had been oozing foul-smelling pus from her arm for 9 months, and a 5-year old boy get a circumcision, to name a few cases. (I felt bad that the best thing that I had on me that I could offer him in empathy was a balloon. I’m no medical expert, but I think he’d rather have his foreskin).

In the lab, they had some modern equipment, but every week you’d have to check the memos to find out what labs they couldn’t run because they had no reagents for them. Blood cell counts were done by staining blood and…you guessed it…counting. And malaria tests were done the same way, as I found out first-hand.

I took my prophylactic pills every day, but slept one night without a mosquito net on a church floor in a village outreach. The DEET dropped the ball on this one. A couple weeks later, I had all the symptoms. I’m not 100% sure I had it because never got a conclusive test, but there were good reasons why the tests wouldn’t have worked, and malaria pills knocked it out four days later. So I tell the blood people that I have had malaria... possibly... and they just don’t use part of my blood.

Back when it wasn’t too volatile and they were still sending pre-meds to Nigeria, supposedly it usually worked out that one decides that there are professions other than medicine that are good for them, and the other decides s/he really wants to do medicine. I was definitely the latter.

I’m about to start medical school where things are going to be very different. CTs and MRIs will be there when we need them, there won’t be open windows in the OR, and we can expect the lights to stay on more than 50% of the time.

To be honest, I don’t know if I could practice medicine full-time in a third world country. Don’t get me wrong, I can’t wait to go back for a few weeks at a time, but it would take a lot for me to do that permanently. I’m pretty sure that over time it would frustrate me not being able to do everything possible for the patient, knowing that if I was in Canada I’d be able to offer so much more.

And I don’t want to get malaria.


... possibly.

1 comment:

Anonymous said...

Great story; tell us some more about your experiences in Nigeria.

And, I have to say: what makes you think the CT/MRI is always available here? Just wait till you hit the VA at night. . . or even a plain community hospital. . . :)