The Elephant in the Room.
“If the chances of surviving is between zero and ten, I’m afraid he is closer to one”, the doctor said.
The day started like every normal day, at least it was, until this customer dropped by again. Rasheed had just fixed this customer’s truck the previous week, why was he back? “Oga sometin still dey sound under dis motor”, the customer said. Rasheed agreed to take one more look at this man’s truck only if he would pay an extra 2,000. He disagreed, insisting that he only had half that price. Rasheed consented, he would not pass up a job just because it was not enough money.
Maybe he should have…
As he made to cut off some metallic part off the truck, the blade sprung up from his hands and in a split second. He was covered in a pool of blood with a wide gash to his head.
I stood and watched as his eldest son, who had witnessed the entire incident narrated the story of how his father ended up in the emergency department of the hospital where I was a medical student.
Rasheed would need a brain CT before the extent of damage to his brain could be objectively ascertained. He would then need surgery, the outcomes of which did not bear much hope. “But if we do nothing, he would die”, the doctor explained. Rasheed’s family could barely scrape together enough money for the imaging to be done. He died the next morning.
I, like other medical practitioners (read student) exist in an environment where I am surrounded by many different situations of people who are experiencing life altering circumstances. The death of a loved one, the birth of a child with some disability, an imminent amputation or the diagnosis of a terminal illness. One thing that is however missing from this experience for medical students, is the ‘duty of care’.
Medical students as part of the management team are largely there to learn and on some rare instance, contribute to the patient’s care. The students’ major role however is to absolve all the knowledge, tact and finesse involved in patient care by watching and closely observing the patient’s management by other senior members of the team. They are saddled with the responsibility of constantly asking, “What brought you to the hospital?” when in fact, they cannot do so much about the situation.
When moments of consequence arise, as they often do, the presence of medical students is just as important as the cinematic representation of ghosts. Visible but without any real impact on the situation they are actively observing. However, unlike ghosts, medical students have emotions.
I am curious as to what the effects of being surrounded by grief is. More accurately, what happens to you, when you are a spectator in the grief of other people?
Medical students in Nigeria today are observing from a vantage point, the realities of the Nigerian healthcare system. They observe as an obligation of learning, the quality of patient care and the systemic barriers that affect its delivery. In the same breath, they are witnessing with wide eyes, the abysmal conditions under which they are being prepared to dispense their skill and expertise.
The Nigerian health care system is on the brink of total collapse. The imminence of this collapse is the subject of debates. As the system falls apart brick by brick, medical students are caught in a situation where their education is directly tied to observing the very real consequences of a failing health system on real people. This present situation can be likened to learning to be a firefighter at the scene of a real fire.
With the increasing wave of migration of skilled professionals from the country, the healthcare system stands in a delicate position. A massive brain drain in a country with reducing capacity to replace and retain these professionals is a looming disaster. The gloom deepens with the realisation that the most responsibility to avert this impending crisis lies on a government that has consistently shown a lack of capacity at solving problems.
It is not all doom and gloom and some days are just way better than others. Grief, even when it’s not actively yours to feel, can be a fog. It clouds the ability of the observer to see the good around. Interacting with healthcare from the provider’s standpoint has its rewards. There is no escaping the many sad experiences but on those days, rest in the knowledge that the good days are more.
