By Peace Eneh
Over the summer of 2014, Peace Eneh is working on a survey of knowledge of cancer among physicians and medical students in Nigeria. Read all the posts about her experience here.
Lagos is like New York but more intense. It’s the biggest city in Africa and has a booming economy to match its fast pace of life. There is so much energy. Lagosians are go-getters. The day usually begins around 5:00 a.m. and ends very late at night.
When I step out of the apartment in the morning, I am greeted by an intense sun. As I walk to the bus stop I am enveloped in a frenzy of activities. Everyone is going about their business; there’s so much buying and selling. I even have to jump onto the bus as it moves. Yes, it’s true. I literally have to jump onto a moving bus because everything is in motion. Some of the buses slow down just enough for people to jump off and on. It seems to be regarded as a waste of time to come to a complete stop in this fast-paced city.
While it might seem like there are not enough buses to take people around, the truth is that there are just too many people and too many cars and buses going to too many different places. This causes the roads to be packed at all times. The traffic jams are ridiculously crazy. If you are not ready to be in traffic for at least three hours on any given day, then you would be better off staying at home. And if you are not fit to jump onto a moving vehicle, please visit the gym and try again later.
Yet while the city of Lagos moves at a fast tempo, the systems in place to serve the people are slow and unpredictable. For instance, the internal workings of the Lagos State University Teaching Hospital (LASUTH), the hospital where I am doing my cancer research, can be very slow. As a government-owned hospital, the fees for service are usually subsidized. The hospital therefore has a high patient volume but is understaffed. The wait times are long and the waiting lines are even longer.
I recently visited the cancer clinic, which is run every Tuesday and Friday. There were more patients than could possibly be seen in a single day and there were very few doctors available. The patients who could not be seen on Tuesday have to come back on Friday, and if they are not so lucky they might need to come back again on another day.
This is the same story that we hear all the time about challenges with health-care delivery in resource-limited settings. However, there are also stories of major advancements that are being made that are often neglected. One example is about the Access to Basic Health Care program (ABC for short). The ABC program was started by the wife of the governor of Oyo State in Nigeria. Ibadan is the capital city of Oyo and is very close to Lagos. The ABC program offers free health services to the locals. There are 10 locations within the city of Ibadan and there is access to screening, consultation, and treatment. Each location has a local staff that speaks the language and understands the people and the culture. The offices are equipped with a computer program that helps with the diagnosis of diseases that can be easily treated and managed by the resident nurse. There is one physician in charge of every three units.
One of the physicians is a friend that I know from high school, so I was able to tag along to observe how the clinics are run. Every patient that comes in with malaria symptoms gets tested with their rapid diagnostic tool (RDT). With RDT, a diagnosis of malaria is made in less than five minutes. They are then able to start treatment immediately. They also found that, since these clinics opened, more patients have been able to seek medical attention because it is easily accessible and free to them.
The clinics employ nurses to help with the management of common illnesses like malaria, intestinal worms, and many bacterial infections. The nurses make the initial assessment and leave the more challenging cases for the physicians, thereby reducing the physicians’ work volume and saving time and money. Otherwise, the physicians would be swamped by the multitude of patients waiting for treatment.
I asked my friend about the sustainability of this project. It seems like this aspect of the clinic still needs to be worked out, but in the meantime there is something being done to improve access. We as rising physicians have to look at what is being done, what is already on the ground, and find ways to make these processes better and sustainable.
My cancer education research has been going on for a few weeks now and I have already learned the value of local partnership. Not just any partner, but one who speaks the language. I am referring not just to the local language of the people in the area but also to the language of the system and the institution. This will make your life exponentially easier.
My partner is Dr. Dennis Hogan. He is definitely knows his way around LASUTH. He is very friendly and professional and knows how to speak LASUTH. I pretty much let him do a big chunk of the talking, because as soon as I try to explain anything, the people quickly recognize that I am not from the area and either try to make things more challenging or they ask me to go and see someone else.
Don’t get me wrong, coming from the U.S. definitely carries prestige, and people are willing to entertain questions and even listen to what I have to say. But there are many protocols and paperwork. When someone tells you to go see a certain person, it could be a coded way of telling you that might have to sweet talk that person to get the necessary permissions.
With the help of Dr. Hogan and other local collaborators, I have been able to obtain the necessary approvals that I need, and my project is well on the way to being completed. One of the medical students helped us go from room to room to identify and survey the medical students and one of our local collaborators got his colleagues to complete the surveys for the physicians.
So I will leave you for now with this very important lesson: local collaboration and partnership is invaluable to a successful global health experience.
Originally from Nigeria, Peace Eneh (’17) moved to the U.S. in 2007 to attend Concordia College in Minnesota. She spent two years working as a clinical research coordinator at Masschusetts General Hospital before arriving at Geisel in the fall of 2013.